Inflamm Bowel Dis. 2024 Sep 3;30(9):1443-1453. doi: 10.1093/ibd/izad196.

Lauren V Collen ¹, Vanessa Mitsialis ², David Y Kim ¹, Mairead Bresnahan ¹, Jessica Yang ¹, Margaret Tuthill ¹, Abigail Combs ¹, Jared Barends ¹, Michael Field ¹, Enju Liu ^1 3, Richelle Bearup ¹, Ibeawuchi Okoroafor ¹, Christoph Klein ⁴, Aleixo M Muise ^5 6 7, Athos Bousvaros ¹, Jodie Ouahed ¹, Scott B Snapper ¹

Author information

¹Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA.

²Division of Gastroenterology, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.

³Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, 02115, USA.

⁴Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, and Gene Center, Ludwig Maximilians Universität München, Germany.

⁵SickKids Inflammatory Bowel Disease Center, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.

⁶Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

⁷Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.

Abstract

Background: Very early onset inflammatory bowel disease (VEOIBD) is defined as disease onset in patients younger than 6 years. Challenges in treatment of VEOIBD include lack of approved therapies and increased incidence of monogenic immunodeficiencies. We report on patterns of anti-TNF use, efficacy, and safety in a large cohort of patients with VEOIBD.

Methods: Very early onset inflammatory bowel disease patients receiving care at a single center were prospectively enrolled in a data registry and biorepository starting in 2012. Whole exome sequencing was available to all patients. Clinical data including IBD medication use and response were extracted from the medical record. We examined antitumor necrosis factor (anti-TNF) cumulative exposure and time to failure and evaluated the effect of covariates on anti-TNF failure using Cox proportional hazard regression.

Results: In this cohort of 216 VEOIBD patients with median 5.8-year follow-up, 116 (53.7%) were TNF-exposed. Sixty-two TNF-exposed patients (53.4%) received their first dose at younger than 6 years. Cumulative exposure to anti-TNF was 23.6% at 1 year, 38.4% at 3 years, and 43.4% at 5 years after diagnosis. Cumulative exposure was greater in patients with Crohn's disease (P = .0004) and in those diagnosed in 2012 or later (P < .0001). Tumor necrosis factor failure occurred in 50.9% of those exposed. Features predictive of anti-TNF failure included ulcerative colitis/IBD-unclassified (hazard ratio, 1.94; P = .03), stricturing (hazard ratio, 2.20; P = .04), and younger age at diagnosis (hazard ratio, 1.25; P = .01). Adverse events occurred in 22.6% of infliximab-exposed and 14.3% of adalimumab-exposed.

Conclusions: Efficacy and safety of anti-TNFs in VEOIBD is comparable to what has previously been reported in older patients.