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 Internal Medicine and Institute of Pharmacology 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Paediatrics 1st Faculty of Medicine Thomayer University Hospital and Charles University Prague Czech Republic

Department of Paediatrics 2nd Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic

Department of Paediatrics and Inherited Metabolic Disorders 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Department of Paediatrics Faculty of Medicine and Dentistry University Hospital Olomouc Olomouc Czech Republic

Department of Paediatrics Faculty of Medicine in Pilsen Faculty Hospital Charles University Prague Pilsen Czech Republic

Department of Paediatrics Faculty of Medicine Masaryk University and University Hospital Brno Brno Czech Republic

Department of Paediatrics Hospital Ceske Budejovice Ceske Budejovice Czech Republic

Department of Paediatrics Hospital Jihlava Jihlava Czech Republic

Department of Paediatrics University Hospital Ostrava and Medical Faculty University of Ostrava Ostrava Czech Republic

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