The Safety and Effectiveness of Early Anti-tumor-necrosis-factor Therapy for Penetrating Crohn's Disease Complications in Children.

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.