The American journal of gastroenterology · 2026
The Safety and Effectiveness of Early Anti-tumor-necrosis-factor Therapy for Penetrating Crohn's Disease Complications in Children.
СтатьяНазвание и аннотация: Перевод в очереди
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Constant Brad D, Feng Yixuan, Huang Jing, Okraku-Mantey Janet, Adler Jeremy, Ali Sabina, Barry Jessica, Cruz Rusvelda, Crawford Erin C, Dotson Jennifer L, Ewalt Mary Kate, Huang Jeannie S, Kachelries Kelly, Kurowski Jacob A, Minar Phillip, Mitchel Elana B, Montminy Taylor D, Morrow Ryan, Pasternak Brad, Rabizadeh Shervin, Sauer Cary G, Shapira Tal, Sunseri Whitney M, Tarabishy Ibrahim, Trombler Becca, Anupindi Sudha A, Baldassano Robert N, de Zoeten Edwin F, Scott Frank I, Albenberg Lindsey
Аннотация
INTRODUCTION: Children with Crohn's disease (CD) who develop internally penetrating complications (IPCs; abscesses and inflammatory masses) are at high risk of surgery and other adverse events. Early anti-tumor-necrosis-factor therapy (anti-TNF) improves outcomes among children with CD and anti-TNF initiation soon after IPC resolution decreases surgical risk. We aimed to evaluate the safety and effectiveness of early anti-TNF therapy among children hospitalized with active IPCs.
METHODS: We conducted a multicenter retrospective study of children (age 6 years and older) diagnosed with IPCs from 2007 to 2021. The exposure was anti-TNF within 30 days of IPC diagnosis. Outcomes included (i) infectious serious adverse events (iSAE) within 90 days, (ii) noninfectious CD-related SAE (cdSAE), (iii) CD-related surgery, and (iv) combined clinical-biochemical-corticosteroid-free remission within 1 year. Outcomes were compared by inverse-probability-of-treatment-weighted Kaplan-Meier curves (log-rank test) and Cox proportional hazards models stratified by percutaneous drainage (PD) status.
RESULTS: Among 203 patients (median age 16 years, 50% girls), 87 (43%) received early anti-TNF within 30 days of IPC diagnosis. In Cox analyses, early anti-TNF was not linked to iSAE, cdSAE, or surgeries, but was associated with increased combined clinical-biochemical-corticosteroid-free remission (hazard ratio 1.65, 95% CI 1.20-2.27). However, surgical risk differed by PD status: patients receiving early anti-TNF and PD had lower risk versus PD alone (event-free survival 58% vs 15%, log-rank P = 0.04).
DISCUSSION: Early anti-TNF therapy in children with IPCs was not associated with iSAE or cdSAE. Notably, in those undergoing PD, early anti-TNF was associated with decreased surgeries. These findings support early anti-TNF initiation within a multidisciplinary treatment framework. Prospective studies with standardized treatment protocols are needed.
METHODS: We conducted a multicenter retrospective study of children (age 6 years and older) diagnosed with IPCs from 2007 to 2021. The exposure was anti-TNF within 30 days of IPC diagnosis. Outcomes included (i) infectious serious adverse events (iSAE) within 90 days, (ii) noninfectious CD-related SAE (cdSAE), (iii) CD-related surgery, and (iv) combined clinical-biochemical-corticosteroid-free remission within 1 year. Outcomes were compared by inverse-probability-of-treatment-weighted Kaplan-Meier curves (log-rank test) and Cox proportional hazards models stratified by percutaneous drainage (PD) status.
RESULTS: Among 203 patients (median age 16 years, 50% girls), 87 (43%) received early anti-TNF within 30 days of IPC diagnosis. In Cox analyses, early anti-TNF was not linked to iSAE, cdSAE, or surgeries, but was associated with increased combined clinical-biochemical-corticosteroid-free remission (hazard ratio 1.65, 95% CI 1.20-2.27). However, surgical risk differed by PD status: patients receiving early anti-TNF and PD had lower risk versus PD alone (event-free survival 58% vs 15%, log-rank P = 0.04).
DISCUSSION: Early anti-TNF therapy in children with IPCs was not associated with iSAE or cdSAE. Notably, in those undergoing PD, early anti-TNF was associated with decreased surgeries. These findings support early anti-TNF initiation within a multidisciplinary treatment framework. Prospective studies with standardized treatment protocols are needed.