Drug-related adverse events necessitating treatment discontinuation in pediatric inflammatory bowel disease patients.

BACKGROUND AND AIMS Inflammatory bowel disease (IBD) requires long-term drug therapy in most patients, posing a risk for adverse drug events with the need for discontinuation. In this study, we investigated adverse events (AE) necessitating drug discontinuation in pediatric and adolescent IBD patients. METHODS We used data prospectively collected from IBD patients below the age of 18 enrolled in the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS), namely demographic variables, medical characteristics, drug treatments and related AE. We analysed the frequency, type, and risk factors for AE necessitating drug discontinuation. RESULTS A total of 509 pediatric IBD patients fulfilled the inclusion criteria of which 262 (51.5%) were diagnosed with Crohn's disease (CD), 206 (40.5%) with ulcerative colitis (UC), and 41 (8%) with IBD-unclassified (IBD-U). In total, 132 (25.9%) presented with at least one drug-related AE that required drug cessation. Immunomodulators (methotrexate 29/120 (24.2%), azathioprine 57/372 (15.3%)) followed by tumor necrosis factor (TNF)-alpha antagonists (adalimumab 8/72 (11.1%), infliximab 22/227 (9.7%)) accounted for the highest proportions of AE necessitating treatment discontinuation. Treatment schemes with at least 3 concomitant drugs significantly amplified the risk for development of drug-related AE (OR = 2.50, 95%CI [1.50-4.17]) in all pediatric IBD patients. CONCLUSIONS Drug-related AE necessitating discontinuation are common in pediatric and adolescent inflammatory bowel disease patients. Caution needs to be taken in the case of concomitant drug use

Impact of Diagnostic Delay on Disease Course in Pediatric- versus Adult-Onset Patients with Ulcerative Colitis: Data from the Swiss IBD Cohort

INTRODUCTION Given the lack of data, we aimed to assess the impact of the length of diagnostic delay on the natural history of ulcerative colitis (UC) in pediatric (diagnosed <18 years) and adult patients (diagnosed ≥18 years). METHODS Data from the Swiss Inflammatory Bowel Disease Cohort Study were analyzed. Diagnostic delay was defined as the interval between the first appearance of UC-related symptoms until diagnosis. Logistic regression modeling evaluated the appearance of the following complications in the long term according to the length of diagnostic delay: colonic dysplasia, colorectal cancer, UC-related hospitalization, colectomy, and extraintestinal manifestations (EIMs). RESULTS A total of 184 pediatric and 846 adult patients were included. The median diagnostic delay was 4 [IQR 2-7.5] months for the pediatric-onset group and 3 [IQR 2-10] months for the adult-onset group (p = 0.873). In both, pediatric- and adult-onset groups, the length of diagnostic delay at UC diagnosis was not associated with colectomy, UC-related hospitalization, colon dysplasia, and colorectal cancer. EIMs were significantly more prevalent at UC diagnosis in the adult-onset group with long diagnostic delay than in the adult-onset group with short diagnostic delay (p = 0.022). In the long term, the length of diagnostic delay was associated in the adult-onset group with colorectal dysplasia (p = 0.023), EIMs (p < 0.001), and more specifically arthritis/arthralgias (p < 0.001) and ankylosing spondylitis/sacroiliitis (p < 0.001). In the pediatric-onset UC group, the length of diagnostic delay in the long term was associated with arthritis/arthralgias (p = 0.017); however, it was not predictive for colectomy and UC-related hospitalization. CONCLUSIONS As colorectal cancer and EIMs are associated with considerable morbidity and costs, every effort should be made to reduce diagnostic delay in UC patients

Impact of overweight and obesity on disease outcome in the Pediatric Swiss Inflammatory Bowel Disease Cohort

Objectifs : Face à la rareté des données pédiatriques sur l’obésité dans le cadre de maladie inflammatoire chronique de l'intestin (MICI), nous avons cherché à évaluer l'impact de celle-ci sur l'activité de la maladie, les complications et la qualité de vie des patients pédiatriques atteints de MICI. Méthodes : Analyse prospective de patients pédiatriques atteints de MICI. Les patients ont été classés en 4 groupes selon les normes de croissance de l'Organisation mondiale de la santé : obésité, surpoids, poids normal et insuffisance pondérale. Résultats : 327 patients pédiatriques ont été inclus (146 atteints de maladie de Crohn [MC], 181 de colite ulcéreuse [CU]), dont 13 (4%) étaient en sous-poids, 272 (83,2%) avaient un poids normal, 22 (6,7%) étaient en surpoids et 20 (6,1%) étaient obèses. En comparaison aux patients de poids normal, les patients obèses avec CU présentaient une activité clinique mais non biologique ainsi qu’une sévérité de la maladie significativement plus élevées. Par rapport aux patients de poids normal, les patients atteints de MC en surpoids ou obèses ne présentaient pas une activité de la maladie clinique ou biologique ni une sévérité plus élevées. Les abcès périanaux et les interventions chirurgicales à cette effet étaient plus fréquemment observés chez les patients atteints de MC en surpoids/obèses que chez les patients de poids normal. Les patients atteints de MICI en surpoids/obèses ont été hospitalisés de façon similaire au cours des 12 derniers mois par rapport aux patients de poids normal. Conclusions : La prévalence du surpoids et de l'obésité était de 12,8 % chez les patients pédiatriques atteints de MICI. L'obésité n'était pas associée à une diminution du taux de rémission de la maladie ni à une augmentation du risque de progression compliquée de la maladie chez les patients pédiatriques atteints de MICI, à l'exception de la survenue d'abcès périanaux et de chirurgie à cet effet chez les patients atteints de MC