Background: Anti-TNF therapy is actually easy available for inflammatory bowel disease treatment. Even if biologics are commonly used for many years, surveillance, especially focusing at safety is needed. In that case, study to assess efficacy and prevalence of adverse events in Polish cohort adult and pediatric patients with Crohn's disease (CD) and ulcerative colitis (UC) has been started. In database were recorded information about demographic and medical history. The aim of actual assessment was to compare disease presentation between children and adults with inflammatory bowel disease qualified to anti-TNF therapy.
Methods: A multicenter, prospective cohort observational study was started at January 2014. To study were included all patients in every age who started anti-TNF treatment. From final assessment were excluded 74 patient due to lack of complete data. Data were recorded with use of electronical database. Demographical findings, collateral diseases, history of treatment were also collected. Finally, 667 patients were enrolled to the study. Group consist 397 adults (59.6%) and 270 patients aged below 18 years old (40.4%).
Results: Time from first symptoms to diagnosis varied between type of disease and age. Diagnosis was performed earlier for patients aged below 18 years. Mean time was 4 months for UC and 6.9 months for CD in pediatric population vs 7.8 months and 12 months in adults, respectively. At the moment of anti-TNF qualification, most UC patients presented high disease severity. 58,0% adults and 60.4% children were definied as E3 in Montreal classification. Among CD patients the most common disease localisation in children were colon (40.2%) and terminal ileum (38.3%) meanwhile terminal ileum in adults were affected only in 29.3%. The most common disease localisation in adults were large intestine (44.3%). Upper digestive tract were 4 times more common affected in children 27.1%; vs 7.2% in adults. Most patients were qualified to biological treatment due to luminal active disease. Nevertheless, young patients with CD earlier than adults needed biological therapy. Mean time from diagnosis to treatment with biologic therapy was 1.4 years for children with CD, and 5.8 years for adults. Mean time among UC patients were 2.0 years for children and 4.3 years for adults.
Conclusions: Analysis showed that pediatric patients mostly have more aggressive form of disease what lead to earlier disease diagnosis and earlier need of anti-TNF treatment. In comparison to adults, in children with CD, localisation is more common in terminal ileum and upper digestive track.