Kwon Y, Kim ES, Choe YH, Kim MJ. How has the disease course of pediatric ulcerative colitis changed throughout the biologics era? A comparison with the IBSEN study. World J Gastroenterol 2022; 28(28): 3666-3681 [PMID: 36161040 DOI: 10.3748/wjg.v28.i28.3666]
Corresponding Author of This Article
Mi Jin Kim, MD, PhD, Associate Professor, Department of Pediatrics, Samsung Medical Center, Ilwon-ro 81, Gangnam-gu, Seoul 06351, South Korea.mijin1217.kim@samsung.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jul 28, 2022; 28(28): 3666-3681 Published online Jul 28, 2022. doi: 10.3748/wjg.v28.i28.3666
How has the disease course of pediatric ulcerative colitis changed throughout the biologics era? A comparison with the IBSEN study
Yiyoung Kwon, Eun Sil Kim, Yon Ho Choe, Mi Jin Kim
Yiyoung Kwon, Yon Ho Choe, Mi Jin Kim, Department of Pediatrics, Samsung Medical Center, Seoul 06351, South Korea
Eun Sil Kim, Department of Pediatrics, Kangbuk Samsung Medical Center, Seoul 03181, South Korea
Author contributions: Kwon Y designed and performed the research and wrote the paper; Kim MJ designed the research and supervised the report; Kim ES and Choe YH designed the research and contributed to the analysis.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Samsung Medical Center (IRB File No. SMC 2020-12-005).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflict of interests to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mi Jin Kim, MD, PhD, Associate Professor, Department of Pediatrics, Samsung Medical Center, Ilwon-ro 81, Gangnam-gu, Seoul 06351, South Korea.mijin1217.kim@samsung.com
Received: September 28, 2021 Peer-review started: September 28, 2021 First decision: November 18, 2021 Revised: November 21, 2021 Accepted: June 30, 2022 Article in press: June 30, 2022 Published online: July 28, 2022 Processing time: 301 Days and 17.3 Hours
Abstract
BACKGROUND
In Korea, infliximab was approved for use in children with ulcerative colitis (UC) in October 2012.
AIM
To compare the clinical course of UC before and after the introduction of biological agents, and to compare with the IBSEN study.
METHODS
Patients under 18 years of age, who were diagnosed with UC and followed from January 2003 to October 2020, were included in the study. Group A (n = 48) was followed for at least 2 years between January 2003 and October 2012, and Group B (n = 62) was followed for at least 2 years between November 2012 and October 2020. We compared endoscopic remission, drug composition, relapse rate, steroid-free period, and the quality of life of each group. We plotted the clinical course of the included patients using the pediatric UC activity index score, and compared our patients with those in the IBSEN study.
RESULTS
After 2 years of treatment, colonoscopy evaluation revealed different outcomes in the two treatment groups. Remission was confirmed in 14 patients (29.2%) of Group A, and in 31 patients (50.0%) of Group B (P < 0.012). The median cumulative corticosteroid-free period was 3.0 years in Group A and 4.4 years in Group B. Steroid-free period of Group B was significantly longer than that of Group A (P < 0.001). There was a statistically significant difference between the two groups in evaluation of the relapse rate during the observation period (P < 0.001). The plotted clinical course graphs of Group A showed similar proportions to the graphs in the IBSEN study. However, in Group B, the proportion of patients corresponding to curve 1 (remission or mild severity after initial high activity) was high at 76% (47/62).
CONCLUSION
The incidence of relapse has decreased and the steroid-free period has increased after the introduction of the biological agent. The clinical course also showed a different pattern from that of IBSEN study. The active use of biological agents may change the long-term disease course in moderate to severe pediatric UC.
Core Tip: This was a retrospective study that assessed how the introduction of biological agents has altered the disease course over time in pediatric ulcerative colitis (UC). Endoscopic remission, relapse rate, steroid-free period, and the quality of life of each group were evaluated as outcomes. Clinical course was plotted with the pediatric UC activity index score, and compared to that of the IBSEN study. The incidence of relapse has decreased and the steroid-free period has increased after the introduction of biological agents. The clinical course also showed a different pattern from the IBSEN study.
