P147 Progression to biologic treatment in very early onset inflammatory bowel disease patients- a long term follow up retrospective study
Eindor, A.(1);Meleady, L.(1);Jacobson, K.(1);
(1)British Columbia Children’s Hospital- University of British Columbia, Division of Gastroenterology- Hepatology and Nutrition, Vancouver, Canada
Very early onset inflammatory bowel disease (VEOIBD) prevalence has been increasing over the last decades. These young patients have been known to have special disease characteristics and disease location. Although it is known that only a low percentage of these patients require biologic treatment after diagnosis, there is only scarce evidence about their long- term outcome and biologic requirements. We aimed to assess the long term outcome of VEOIBD patients and the time of progression to biologic treatment.
We retrospectively reviewed IBD patients diagnosed under 6 years of age, between January 2005 and December 2019, from the British Columbia (BC) Pediatric IBD database. Demographic data, disease characteristics and symptoms at diagnosis were documented. The disease location and severity were documented according to the Paris classification. Data collected retrospectively until the last appointment recorded in the electronic medical records included whether the patient received biologic treatment at the time of follow up, the time to intiation of the treatment, the type of biologic treatment and response. Kaplan meier curves were used to asses the number of years to progression to biologic treatment and the parameters influencing it.
89 patients under the age of 6 were diagnosed with IBD during the study period. 3 patients failed to meet inclusion criteria and were excluded. Median age at diagnosis was 3.8 (IQR 2.6-5.1). 45.3% of patients had Crohn’s disease (CD) and 62.8% were males. Median time of follow up was 6.39 (IQR 3.71-10.55). 68.1% of the ulcerative colitis (UC) patients had pancolitis and 48.7% of CD patients had ileocolonic disease. 39.5% of patients were started on biologic treatment and 7.1% underwent surgery. Kaplan Meier curves demonstrated that patients diagnosed in the years 2012 -2019 had shorter duration of progression to biologics than those diagnosed 2005-2011 (p=0.0047). In patients with CD those with perianal or stricturing disease progressed faster to biologic treatment (p=0.024,p=0.038, respectively) and in UC patients those with high severity of disease (p=0.017). 63.6% of patients were reported to be on clinical remission on the biologic treatment.
Although VEOIBD patients have more extensive diseas, they require less biologic treatment than previously reported in older patients. Factors influencing shorter duration of progression to biologics were the severity of disease and behaviour and not disease location. Patients diagnosed more recently had shorter duration to biologic treatment which might reflect physicians perception on using biologic treatment in these young patients rather than disease severity.