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Sustainability of biologic treatment in paediatric patients with Crohn's disease: population-based registry analysis
O. Hradsky, I. Copova, M. Durilova, D. Kazeka, T. Lerchova, K. Mitrova, J. Schwarz, R. Vetrovcova, N. El-Lababidi, E. Karaskova, M. Veghova-Velganova, A. Sulakova, L. Gonsorčíková, M. Veverkova, I. Zeniskova, M. Zimen, M. Bortlik, J. Bronsky
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články
NLK
Free Medical Journals
od 1967 do Před 1 rokem
ProQuest Central
od 2016-01-01 do Před 1 rokem
Health & Medicine (ProQuest)
od 2016-01-01 do Před 1 rokem
Public Health Database (ProQuest)
od 2016-01-01 do Před 1 rokem
- MeSH
- adalimumab * terapeutické užití MeSH
- biologické přípravky terapeutické užití MeSH
- Crohnova nemoc * farmakoterapie MeSH
- dítě MeSH
- humanizované monoklonální protilátky terapeutické užití MeSH
- infliximab * terapeutické užití MeSH
- lidé MeSH
- mladiství MeSH
- proporcionální rizikové modely MeSH
- prospektivní studie MeSH
- registrace * MeSH
- tendenční skóre MeSH
- ustekinumab terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: We aimed to evaluate the predictors of sustainability of biologic drugs for paediatric patients with Crohn's disease (CD). METHODS: The Czech National Prospective Registry of Biologic and Targeted Therapy of Inflammatory Bowel Disease (CREdIT) was used to identify the biologic treatment courses in paediatric patients with CD. Mixed-effects Cox models and propensity score analyses were employed to evaluate predictors of treatment sustainability. RESULTS: Among the 558 observations of 473 patients, 264 were treated with adalimumab (47%), 240 with infliximab (43%), 41 with ustekinumab (7%), and 13 with vedolizumab (2%). Multivariable analysis revealed higher discontinuation risk with infliximab compared to adalimumab (HR = 0.600, 95%CI 0.389-0.926), both overall and in first-line treatment (HR = 0.302, 95%CI 0.103-0.890). Infliximab versus adalimumab was associated with shorter time to escalation (HR = 0.094, 95%CI 0.043-0.203). Propensity-score analysis demonstrated lower sustainability of infliximab (HR = 0.563, 95%CI 1.159-2.725). The time since diagnosis to treatment initiation (HR = 0.852, 95%CI 0.781-0.926) was the most important predictor. Baseline immunosuppressive therapy prolonged sustainability with infliximab (HR = 2.899, 95%CI 1.311-6.410). CONCLUSIONS: Given the results suggesting shorter sustainability, the need for earlier intensification and thus higher drug exposure, and the greater need for immunosuppression with infliximab than with adalimumab, the choice of these drugs cannot be considered completely equitable. IMPACT: Our study identified predictors of sustainability of biologic treatment in paediatric patients with Crohn's disease, including adalimumab (versus infliximab), early initiation of biologic treatment, and normalised baseline haemoglobin levels. Infliximab treatment was associated with earlier intensification, higher drug exposure, and a greater need for immunosuppression. Parents and patients should be fully informed of the disadvantages of intravenous infliximab versus adalimumab during the decision-making process. This study emphasises the importance of not delaying the initiation of biologic therapy in paediatric patients with Crohn's disease.
Department of Gastroenterology Hospital Ceske Budejovice Ceske Budejovice Czech Republic
Department of Paediatrics Hospital Ceske Budejovice Ceske Budejovice Czech Republic
Department of Paediatrics Hospital Jihlava Jihlava Czech Republic
Citace poskytuje Crossref.org
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