Initiating antitumor-necrosis-factor (anti-TNF) therapies before resolving any internally penetrating Crohn disease complication (IPCDC) may be associated with better clinical outcomes, Brad D Constant, MD, MSCS, said during his poster presentation at the Crohn’s and Colitis Congress 2023, in Denver, Colorado.

Dr Constant is an advanced inflammatory bowel disease fellow with the Division of Gastroenterology, Hepatology and Nutrition at Children's Hospital of Philadelphia.

From the pooled interim results of an observational multicenter study across 12 tertiary children’s hospitals, Dr Constant and colleagues sought to understand the rationale behind the limited use of anti-TNFs among patients with IPCDC due to fear of infections.

The final study included 95 patients (more than 6 years of age) who were identified via radiology, ICD coding, and ImproveCareNow searches. All the patients were admitted for an IPCDC between 2007 and 2021, with more than 1 year of follow-up. Patients who required surgery within a week of IPCDC diagnosis were not included in the study.

The team focused on 2 primary outcomes— the safety of anti-TNF following IPCDC diagnosis, prior to IPCDC resolution, on infectious serious adverse events (SAEs); and the effectiveness of anti-TNF within 30 days of IPCDC diagnosis on CD-related SAEs.

Of the 80% of patients who received anti-TNF within 1 year of IPCDC, infectious SAEs within 90 days of IPCDC occurred in 37%. Only 27% of patients who initiated anti-TNF prior to IPCDC resolution had an infectious SAE within 90 days, compared to 49% of those not initiating anti-TNF prior to IPCDC resolution. Noninfectious CD-related SAEs within 1 year occurred in 44% of the patients.

Speaking specifically about CD-related SAEs, Dr Constant noted that among patients initiating anti-TNF within 30 days of IPCDC, 47% had a CD-related SAE, compared to 43% in those not receiving anti-TNF within 30 days,” Dr Constant said.

Based on the results, Dr Constant encouraged initiating anti-TNF therapy prior to resolving any IPCDC. However, “implementation of causal inference methods and subgroup analyses will be critical in isolating the relationship between timing of anti-TNF post-IPCDC and serious adverse events,” he said.

—Priyam Vora

Reference:
Constant B. Presentation number: P051. Multidisciplinary management, anti-TNF therapy, and clinical outcomes of internally penetrating Crohn’s disease complication in pediatrics: Interim analyses of a multicenter retrospective cohort. Presented at: Crohn’s and Colitis Congress 2023; January 19, 2023. Denver, Colorado.