Published online Jul 28, 2022. doi: 10.3748/wjg.v28.i28.3666
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
There are many articles comparing the clinical outcomes of patients treated with biological agents vs those who did not use biological agents, but no studies have compared the disease course of UC by era before and after the introduction of biological agents. The authors assessed how introduction of new treatment altered disease course over time.
The number of large-scale and long-term follow-up studies for pediatric patients with ulcerative colitis (UC) is insufficient. A representative paper dealing with the clinical course of adult UC is the IBSEN study. This paper dealt with the clinical course before the introduction of biological agents. If the use of biological agents in pediatric UC changed the clinical course of UC, it would be helpful in future treatment decisions.
The aim of this study was to compare the clinical course of pediatric UC by era before and after the introduction of biological agents, and to compare them with clinical course curve of the IBSEN study.
Infliximab was approved for use in children in October 2012 in Korea. Group A (n = 48) was followed between January 2003 and October 2012, and Group B (n = 62) was followed between November 2012 and October 2020. Endoscopic remission, drug composition, relapse rate, steroid-free period, and the quality of life of the groups were evaluated as outcomes. Clinical course was plotted with the pediatric UC activity index score, and compared to the curve of the IBSEN study.
Despite a higher rate of pancolitis, patients in Group B had a higher rate of achieving endoscopic remission, longer steroid-free periods and reduced relapse rate. Unlike the clinical course curve of the IBSEN study, we drew one more independent curve (curve 5), and the proportion of the patients in Group B corresponding to curve 1 (remission or mild severity after initial high activity) was higher. In terms of quality of life, the number of hospitalizations and emergency room visits have improved after the introduction of biological agents. Comparison of treatment costs is also an important issue that needs future research.
The active use of biological agents may change the long-term disease course in moderate to severe pediatric UC. Growth can also be achieved by reducing the use of steroids.
Because biological agents are an expensive treatment option, whether there is a difference in economic quality of life caused by treatment with biological agents is also an important topic for future research.