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Long-term outcomes with anti-TNF therapy and accelerated step-up in the prospective pediatric Belgian Crohnʼs disease registry (BELCRO)

Lucas Wauters, Françoise Smets, Elisabeth De Greef, Patrick Bontems, Ilse Hoffman, Bruno Hauser, Philippe Alliet, Wim Arts, Harald Peeters (UGent) , Stephanie Van Biervliet (UGent) , et al.
(2017) INFLAMMATORY BOWEL DISEASES. 23(9). p.1584-1591
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Abstract
Background: Accelerated step-up or anti-tumor necrosis factor (TNF) before first remission is currently not recommended in pediatric Crohn's disease. Methods: Five-year follow-up data from a prospective observational cohort of children diagnosed with Crohn's disease in Belgium were analyzed. Disease severity was scored as inactive, mild, or moderate to severe. Remission or inactive disease was defined as sustained if lasting >= 2 years. Univariate analyses were performed between anti-TNF-exposed versus naive patients and anti-TNF before versus after first remission and correlations assessed with primary outcomes average disease severity and sustained remission. Results: A total of 91 patients (median [IQR] age 12.7 [10.9-14.8] yrs, 53% male) were included. Disease location was 12% L1, 23% L2, and 64% L3 with 76% upper gastrointestinal and 30% perianal involvement. Disease severity was 25% mild and 75% moderate to severe. Of 66 (73%) anti-TNF-exposed patients, 34 (52%) had accelerated step-up. Anti-TNF use was associated with age (13.1 [11.5-15.2] versus 11.8 [8.7-13.8] yrs; P < 0.05), L2 (29% versus 8%; P = 0.04), and average disease severity (1.7 [1.4-1.9] versus 1.4 [1.3-1.6]; P < 0.001). Duration of anti-TNF correlated with average disease severity (r = 0.32, P = 0.002). Accelerated step-up was also associated with age (13.3 [12.1-15.9] versus 12.5 [10.2-14.1]; P = 0.02) and average disease severity (1.8 [1.6-1.9] versus 1.6 [1.3-1.8]; P = 0.002). Duration of sustained remission was similar in all patients, and no serious infections, cancer, or deaths were reported. Conclusions: Anti-TNF therapy and accelerated step-up in older patients with more severe disease leads to beneficial long-term outcomes.
Keywords
Crohn's disease, anti-TNF, pediatric, outcome, INFLAMMATORY-BOWEL-DISEASE, INFLIXIMAB THERAPY, NATURAL-HISTORY, CHILDREN, MANAGEMENT, DIAGNOSIS, MODERATE, IMMUNOMODULATOR, STRATEGY, ALPHA

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MLA
Wauters, Lucas, et al. “Long-Term Outcomes with Anti-TNF Therapy and Accelerated Step-up in the Prospective Pediatric Belgian Crohnʼs Disease Registry (BELCRO).” INFLAMMATORY BOWEL DISEASES, vol. 23, no. 9, 2017, pp. 1584–91, doi:10.1097/mib.0000000000001193.
APA
Wauters, L., Smets, F., De Greef, E., Bontems, P., Hoffman, I., Hauser, B., … Veereman, G. (2017). Long-term outcomes with anti-TNF therapy and accelerated step-up in the prospective pediatric Belgian Crohnʼs disease registry (BELCRO). INFLAMMATORY BOWEL DISEASES, 23(9), 1584–1591. https://doi.org/10.1097/mib.0000000000001193
Chicago author-date
Wauters, Lucas, Françoise Smets, Elisabeth De Greef, Patrick Bontems, Ilse Hoffman, Bruno Hauser, Philippe Alliet, et al. 2017. “Long-Term Outcomes with Anti-TNF Therapy and Accelerated Step-up in the Prospective Pediatric Belgian Crohnʼs Disease Registry (BELCRO).” INFLAMMATORY BOWEL DISEASES 23 (9): 1584–91. https://doi.org/10.1097/mib.0000000000001193.
Chicago author-date (all authors)
Wauters, Lucas, Françoise Smets, Elisabeth De Greef, Patrick Bontems, Ilse Hoffman, Bruno Hauser, Philippe Alliet, Wim Arts, Harald Peeters, Stephanie Van Biervliet, Isabelle Paquot, Els Van de Vijver, Martine De Vos, Peter Bossuyt, Jean-François Rahier, Olivier Dewit, Tom Moreels, Denis Franchimont, Vincianne Muls, Fernand Fontaine, Edouard Louis, Jean-Charles Coche, Filip Baert, Jérôme Paul, Séverine Vermeire, and Geneviève Veereman. 2017. “Long-Term Outcomes with Anti-TNF Therapy and Accelerated Step-up in the Prospective Pediatric Belgian Crohnʼs Disease Registry (BELCRO).” INFLAMMATORY BOWEL DISEASES 23 (9): 1584–1591. doi:10.1097/mib.0000000000001193.
Vancouver
1.
Wauters L, Smets F, De Greef E, Bontems P, Hoffman I, Hauser B, et al. Long-term outcomes with anti-TNF therapy and accelerated step-up in the prospective pediatric Belgian Crohnʼs disease registry (BELCRO). INFLAMMATORY BOWEL DISEASES. 2017;23(9):1584–91.
IEEE
[1]
L. Wauters et al., “Long-term outcomes with anti-TNF therapy and accelerated step-up in the prospective pediatric Belgian Crohnʼs disease registry (BELCRO),” INFLAMMATORY BOWEL DISEASES, vol. 23, no. 9, pp. 1584–1591, 2017.
@article{8552391,
  abstract     = {{Background: Accelerated step-up or anti-tumor necrosis factor (TNF) before first remission is currently not recommended in pediatric Crohn's disease. 
Methods: Five-year follow-up data from a prospective observational cohort of children diagnosed with Crohn's disease in Belgium were analyzed. Disease severity was scored as inactive, mild, or moderate to severe. Remission or inactive disease was defined as sustained if lasting >= 2 years. Univariate analyses were performed between anti-TNF-exposed versus naive patients and anti-TNF before versus after first remission and correlations assessed with primary outcomes average disease severity and sustained remission. 
Results: A total of 91 patients (median [IQR] age 12.7 [10.9-14.8] yrs, 53% male) were included. Disease location was 12% L1, 23% L2, and 64% L3 with 76% upper gastrointestinal and 30% perianal involvement. Disease severity was 25% mild and 75% moderate to severe. Of 66 (73%) anti-TNF-exposed patients, 34 (52%) had accelerated step-up. Anti-TNF use was associated with age (13.1 [11.5-15.2] versus 11.8 [8.7-13.8] yrs; P < 0.05), L2 (29% versus 8%; P = 0.04), and average disease severity (1.7 [1.4-1.9] versus 1.4 [1.3-1.6]; P < 0.001). Duration of anti-TNF correlated with average disease severity (r = 0.32, P = 0.002). Accelerated step-up was also associated with age (13.3 [12.1-15.9] versus 12.5 [10.2-14.1]; P = 0.02) and average disease severity (1.8 [1.6-1.9] versus 1.6 [1.3-1.8]; P = 0.002). Duration of sustained remission was similar in all patients, and no serious infections, cancer, or deaths were reported. 
Conclusions: Anti-TNF therapy and accelerated step-up in older patients with more severe disease leads to beneficial long-term outcomes.}},
  author       = {{Wauters, Lucas and Smets, Françoise and De Greef, Elisabeth and Bontems, Patrick and Hoffman, Ilse and Hauser, Bruno and Alliet, Philippe and Arts, Wim and Peeters, Harald and Van Biervliet, Stephanie and Paquot, Isabelle and Van de Vijver, Els and De Vos, Martine and Bossuyt, Peter and Rahier, Jean-François and Dewit, Olivier and Moreels, Tom and Franchimont, Denis and Muls, Vincianne and Fontaine, Fernand and Louis, Edouard and Coche, Jean-Charles and Baert, Filip and Paul, Jérôme and Vermeire, Séverine and Veereman, Geneviève}},
  issn         = {{1078-0998}},
  journal      = {{INFLAMMATORY BOWEL DISEASES}},
  keywords     = {{Crohn's disease,anti-TNF,pediatric,outcome,INFLAMMATORY-BOWEL-DISEASE,INFLIXIMAB THERAPY,NATURAL-HISTORY,CHILDREN,MANAGEMENT,DIAGNOSIS,MODERATE,IMMUNOMODULATOR,STRATEGY,ALPHA}},
  language     = {{eng}},
  number       = {{9}},
  pages        = {{1584--1591}},
  title        = {{Long-term outcomes with anti-TNF therapy and accelerated step-up in the prospective pediatric Belgian Crohnʼs disease registry (BELCRO)}},
  url          = {{http://dx.doi.org/10.1097/mib.0000000000001193}},
  volume       = {{23}},
  year         = {{2017}},
}
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