How has the disease course of pediatric ulcerative colitis changed throughout the biologics era? A comparison with the IBSEN study

Abstract

BACKGROUND

In Korea, infliximab was approved for use in children with ulcerative colitis (UC) in October 2012.

AIM

To compare the clinical course of UC before and after the introduction of biological agents, and to compare with the IBSEN study.

METHODS

Patients under 18 years of age, who were diagnosed with UC and followed from January 2003 to October 2020, were included in the study. Group A (n = 48) was followed for at least 2 years between January 2003 and October 2012, and Group B (n = 62) was followed for at least 2 years between November 2012 and October 2020. We compared endoscopic remission, drug composition, relapse rate, steroid-free period, and the quality of life of each group. We plotted the clinical course of the included patients using the pediatric UC activity index score, and compared our patients with those in the IBSEN study.

RESULTS

After 2 years of treatment, colonoscopy evaluation revealed different outcomes in the two treatment groups. Remission was confirmed in 14 patients (29.2%) of Group A, and in 31 patients (50.0%) of Group B (P < 0.012). The median cumulative corticosteroid-free period was 3.0 years in Group A and 4.4 years in Group B. Steroid-free period of Group B was significantly longer than that of Group A (P < 0.001). There was a statistically significant difference between the two groups in evaluation of the relapse rate during the observation period (P < 0.001). The plotted clinical course graphs of Group A showed similar proportions to the graphs in the IBSEN study. However, in Group B, the proportion of patients corresponding to curve 1 (remission or mild severity after initial high activity) was high at 76% (47/62).

CONCLUSION

The incidence of relapse has decreased and the steroid-free period has increased after the introduction of the biological agent. The clinical course also showed a different pattern from that of IBSEN study. The active use of biological agents may change the long-term disease course in moderate to severe pediatric UC.

Keywords: Colitis; Ulcerative; Children; Infliximab; Relapse; Steroid

Core Tip: This was a retrospective study that assessed how the introduction of biological agents has altered the disease course over time in pediatric ulcerative colitis (UC). Endoscopic remission, relapse rate, steroid-free period, and the quality of life of each group were evaluated as outcomes. Clinical course was plotted with the pediatric UC activity index score, and compared to that of the IBSEN study. The incidence of relapse has decreased and the steroid-free period has increased after the introduction of biological agents. The clinical course also showed a different pattern from the IBSEN study.