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OP014 Use of anti-TNF-α agents in relation to first-time surgery for ulcerative colitis and Crohn's disease during childhood

M.D. Larsen*1, J. Kjeldsen2, N. Qvist3, B. Nørgård1, J. Nielsen1

1Odense University Hospital, Clinical Epidemiology, Odense, Denmark, 2Odense Hospital, Dept. of Medical Gastroenterology S, Odense, Denmark, 3Odense University Hospital, Surgical Department , Odense, Denmark

Background

Following the introduction of anti-tumour necrosis factor-alpha (anti-TNF-α) agents in the medical treatment of inflammatory bowel disease (IBD) it is now debated whether anti-TNF-α agents delay or prevent the need for surgery in childhood and adolescent IBD. It has not earlier been described how the use of anti-TNF-α has been implemented in the actual treatment in relation to surgery based on an unselected nationwide cohort of children with IBD. Based on Danish data from the latest 14 years on patients with ulcerative colitis (UC) and Crohn's disease (CD), we thus aimed to describe the use of anti-TNF-α agents in relation to first time bowel surgery during childhood and adolescence.

Methods

The availability of nationwide Danish registries makes it possible to access data on patients (age ≤21 years) with a diagnosis of CD and UC, the use of anti-TNF-α agents and surgical interventions. We included all Danish children and adolescents having a first time discharge diagnosis of CD or UC during the period from 1 July 2000 through 30 June 2012, with two years of follow up.

The results are reported using descriptive statistics to illustrate the changes in treatment strategy and first time surgical interventions within strata of three years calendar periods.

Results

Overall, 1,609 children and adolescents were diagnosed with CD during the study period. Of these, 344 (21.4%) were at some time treated with anti-TNF-α agents within two years after CD diagnosis, and 36 (2.2%) had a first time surgery within a period of two years from first CD diagnosis. 1,976 children and adolescents were diagnosed with UC. Of these, 228 (11.5%) were treated with anti-TNF-α agents within two years after UC diagnosis, and 169 (8.6%) had a first time surgery within a period of two years from first UC diagnosis.

The anti-TNF-α agents were introduced mid-2003 and hereafter the number of patients treated with anti-TNF-α agents within two years after being diagnosed increased to 173 patients with CD and 126 patients with UC (strata of 2010-2012).

During the study period the number of CD patients, who had a first time surgery was (10, 10, 6, 10 in strata periods of three years) and for UC (44, 47, 42, 36).

The time until first time surgery for CD patients was (median: 6, 27.5, 52.5, 46 weeks in strata periods of three years). The time until first time surgery for UC patients was (median: 23.5, 37, 37.5, 36 weeks).

Conclusion

Following the introduction of anti-TNF-α agents in IBD children and adolescents the number of first time surgeries within two years after diagnosis were at the same level, and the time to surgery seemed to be the same for UC, whereas we observed a tendency that the time to surgery was postponed for patients with CD.