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P345 The Great Continental Divide: use of anti-TNF therapy in paediatric inflammatory bowel disease is significantly different in North America compared with other parts of the world.

P. Church1, J. Hyams2, F. Ruemmele3, L. de Ridder4, D. Turner5, A. Griffiths*1, o.b.o. the International Paediatric IBD Network (PIBDNet)6

1Hospital for Sick Children, University of Toronto, Department of Gastroenterology, Hepatology and Nutrition, Toronto, Canada, 2Connecticut Children’s Medical Centre, Hartford, United States, 3Hospital Necker Enfants Malades, Department of Paediatric Gastroenterology, Paris, France, 4Children’s Hospital Erasmus MC Sophia, Department of Paediatric Gastroenterology, Rotterdam, Netherlands, 5Shaare Zedek Medical Centre, Department of Paediatric Gastroenterology, Jerusalem, Israel, 6International Paediatric IBD Network (PIBDNet), Paris, France


Anti-TNF therapeutic efficacy in paediatric inflammatory bowel disease (IBD) is well established. Therapeutic regimens and positioning relative to immunomodulators (IM) are known to vary internationally, but the magnitude of the variation and its basis have never been systematically explored.

As an initiative of the International Paediatric IBD Network (PIBDNet), we aimed to compare global practice patterns for anti-TNF therapy in paediatric IBD.


An electronic survey was sent to paediatric gastroenterologists world-wide, using national membership lists provided by PIBDNet members was conducted. Questions were related to demographics, practice patterns in Crohn’s disease (CD) and ulcerative colitis (UC), and access limitations. Respondents were asked to estimate the % of their patients treated with anti-TNF ± concomitant IM (thiopurine vs methotrexate), following or without failure of IM.


In total, 346 physicians who treat paediatric IBD in 43 different countries (54% North America, 29% Europe, and 17% elsewhere) responded. Respondents treated a median of 40 IBD patients (IQR 20–95), making up a median 20% (IQR 104–0) of their practices (72% university-based). CD was more often treated with anti-TNF than UC (40% (IQR 25–80) vs 10% (IQR 5–25), p < 0.001). Use of anti-TNF was more common in North America, often without first failing IM (Tables 1 and 2). Infliximab (IFX) monotherapy was more common in North America for all CD and in UC after prior IM failure; use of concomitant IM with IFX in IM-naïve UC patients was similarly common globally. Concomitant IM with adalimumab (ADA) in CD predominated globally. Less thiopurine and more methotrexate use in combination with anti-TNF characterised North American practices for both CD and UC. North Americans more often continued IM indefinitely and less often used standard IFX induction dosing in CD and UC. ADA dosing was similar in all regions. Access limitations were more common in Africa, Asia, Oceania, and South America compared with North America and Europe for both CD (77% vs 30%, p < 0.001) and UC (62% vs 33%, p < 0.001).

Table 1. Practice patterns in luminal Crohn’s disease with infliximab (IFX) and adalimumab (ADA) (percentage of respondents are presented for categorical variables and median (IQR) are presented for continuous variables)

Table 2. Practice patterns in ulcerative colitis with infliximab (percentage of respondents are presented for categorical variables and median (IQR) are presented for continuous variables)


There is significant variation in anti-TNF use in North America where anti-TNF therapy is positioned earlier and thiopurines are avoided. Access limitations appear uncommon in Europe and North America, and likely cannot explain the large observed differences in practice.