Background: The diagnosis of Inflammatory bowel diseases (IBD) during childhood is associated with a more aggressive and extensive phenotype compared with adults, necessitating early introduction of effective therapy. We aimed to study differences in biologic therapy in pediatric and adult IBD patients in the Israeli population.
Methods: IBD cases were identified within the databases of three national health maintenance organizations (HMOs), covering 48% of the Israeli population. Identification as well as differentiation into Crohn's disease (CD) or ulcerative colitis (UC) patients was performed using previously validated algorithms, with the effective date of 31.12.2015. Biologic therapy was determined by pharmacy purchases as recorded by the HMOs; expenses are covered by the national public health care system, ensuring complete unbiased records.
Results: Of 19,780 IBD patients identified, 3,445 (17%) commenced on biologics by 31.12.2015. Children (≤18 years) were twice as likely to be treated with biologics (n=326/1005, 32%) vs. adults (n=3119/18,775, 16%; p<0.001). The difference was more pronounced in UC than CD (CD- 41%/25%, UC- 17%/6%, for pediatrics and adults, respectively). Amongst patients diagnosed between 2005–2015, time in months from diagnosis to initiation of biologics was shorter for children (CD- median: 43 [IQR: 16–80], UC- 48 [19–85]), as compared to adults (CD- 54 [25–90], UC- 66 [37–101]; p<0.001 for both CD and UC, Figs. 1 and 2).
Conclusions: Biologic utilization in pediatric IBD is significantly higher and earlier than in adults. The possible explanations include a more aggressive and extensive disease, differing clinical practices and the role of biologics for the treatment of growth impairment.
This study was supported by a grant from the Leona M. and Harry B. Helmsley Charitable Trust.