The Safety and Effectiveness of Early Anti-Tumor-Necrosis-Factor Therapy for Penetrating Crohn’s Disease Complications in Children
Brad D. Constant, Yixuan Feng, Jing Huang, Janet Okraku-Mantey, Jeremy Adler, Sabina Ali, Jessica Barry, Rusvelda Cruz, Erin C. Crawford, Jennifer L. Dotson, Mary Kate Ewalt, Jeannie S. Huang, Kelly Kachelries, Jacob A. Kurowski, Phillip Minar, Elana B. Mitchel, Taylor D. Montminy, Ryan Morrow, Brad Pasternak, Shervin Rabizadeh, Cary G. Sauer, Tal Shapira, Whitney M. Sunseri, Ibrahim Tarabishy, Becca Trombler, Sudha A. Anupindi, Robert N. Baldassano, Edwin F. de Zoeten, Frank I. Scott, Lindsey AlbenbergBackground and Aims:
Children with Crohn’s Disease (CD) who develop internally penetrating complications (IPCs; abscesses and inflammatory masses) are at high risk for 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) diagnosed with IPCs from 2007-2021. The exposure was anti-TNF within 30 days of IPC diagnosis. Outcomes included 1) infectious serious adverse events (iSAE) within 90 days, 2) non-infectious CD-related SAE (cdSAE), 3) CD-related surgery, and 4) combined clinical-biochemical-corticosteroid-free remission within 1 year. Outcomes were compared via 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% female), 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 (HR 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% versus 15%, log-rank P=0.04).
Conclusions:
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.