Sherlock Mary E, Zachos Mary, Issenman Robert M, Mulder Daniel J
Department of Pediatrics, Division of Pediatric Gastroenterology, McMaster Children's Hospital, Hamilton, Ontario, Canada.
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.
J Can Assoc Gastroenterol. 2020 Oct 15;4(5):e92-e100. doi: 10.1093/jcag/gwaa033. eCollection 2021 Oct.
Biologic agents are a highly useful class of medications for treating inflammatory bowel disease (IBD). Limited evidence exists to guide initiation of biologic therapy, especially in pediatric patients. It is unclear if disease severity is connected to biologic response. We hypothesized that the clinical, biochemical and radiographic characteristics of pediatric IBD at diagnosis were associated with subsequent initiation of biologic therapy.
We performed a retrospective analysis of the charts of all pediatric patients diagnosed with IBD at our centre over 14 years. Kaplan-Meier curves evaluated patient characteristics at diagnosis with time to initiation of biologic therapy. A Cox proportional hazards model was used for multivariate characteristic analysis.
A total of 198 patients were included, 57.6% had Crohn's disease, 27.8% had ulcerative colitis and 14.6% had IBD type unclassified. Mean follow-up time was 47.8 months. About 55.5% of the patients received a biologic medication, the mean time to biologic initiation was 21.5 months. Earlier initiation of biologic therapy was frequently associated with older age, higher disease activity index and lower serum albumin.
Older pediatric patients with more severely active disease and lower serum albumin levels at the time of IBD diagnosis were more likely to initiate biologic therapy when considering biologic initiation, even many years after diagnosis. Identification of these characteristics may help inform decisions to initiate biologic therapy earlier in the IBD disease course.
生物制剂是治疗炎症性肠病（IBD）的一类非常有用的药物。指导生物治疗启动的证据有限，尤其是在儿科患者中。尚不清楚疾病严重程度是否与生物反应相关。我们假设儿科IBD诊断时的临床、生化和影像学特征与随后生物治疗的启动有关。
我们对本中心14年来诊断为IBD的所有儿科患者的病历进行了回顾性分析。Kaplan-Meier曲线评估诊断时的患者特征与生物治疗启动时间。采用Cox比例风险模型进行多变量特征分析。
共纳入198例患者，其中57.6%患有克罗恩病，27.8%患有溃疡性结肠炎，14.6%患有未分类的IBD类型。平均随访时间为47.8个月。约55.5%的患者接受了生物药物治疗，生物治疗启动的平均时间为21.5个月。生物治疗的早期启动通常与年龄较大、疾病活动指数较高和血清白蛋白较低有关。
在考虑启动生物治疗时，IBD诊断时年龄较大、疾病活动更严重且血清白蛋白水平较低的儿科患者更有可能启动生物治疗，即使在诊断多年后也是如此。识别这些特征可能有助于在IBD病程中更早地做出启动生物治疗的决策。
