Abstract
Background: The 2021 ECCO-ESPGHAN guideline on the medical management of paediatric Crohn’s disease promotes early risk stratification and top-down anti-TNF for patients deemed high-risk of severe disease course.
Aims: We aimed to objectively assess the risk-benefit profile of the guideline’s risk stratification policy and guidance on top-down anti-TNF in a nationwide population-based cohort study.
Methods: Using a prospectively identified nationwide cohort of all new paediatric patients (<17 years) diagnosed with Crohn’s disease in Scotland between 01/01/16 and 31/12/20 and retrospectively applying the current management algorithm, we explored the guideline's ability to accurately risk-stratify patients. Phenotypic and treatment data were retrospectively collected from electronic medical records with a maximum of 18 months follow-up post-diagnosis.
Results: Four hundred and eighteen children (258/418 [62%] male; median (IQR) age at diagnosis 13.2 [11.2 – 14.8] years) were included. High-risk phenotype was present in 224/418 (54%) with 53/224 (24%) of high-risk patients not requiring anti-TNF therapy within 18 months of diagnosis. Conversely, 78/194 (40%) of the low-risk group received anti-TNF within 18 months. High-risk patients were more likely to require anti-TNF (171/224 (76%) vs 78/194 (40%), p<0.001) and had shorter median (IQR) time to anti-TNF start (5.0 (1.0 – 8.0) months vs 6.5 (3.3 – 13.0) months, p=0.01).
Conclusions: Our data support the guideline's ability to identify patients more likely to require early treatment escalation. However, this approach would have led to potential over- and under-treatment in a substantial proportion of patients. This underscores the importance of frequent and comprehensive monitoring, along with flexible treatment strategies that adapt to changes in disease status.
Aims: We aimed to objectively assess the risk-benefit profile of the guideline’s risk stratification policy and guidance on top-down anti-TNF in a nationwide population-based cohort study.
Methods: Using a prospectively identified nationwide cohort of all new paediatric patients (<17 years) diagnosed with Crohn’s disease in Scotland between 01/01/16 and 31/12/20 and retrospectively applying the current management algorithm, we explored the guideline's ability to accurately risk-stratify patients. Phenotypic and treatment data were retrospectively collected from electronic medical records with a maximum of 18 months follow-up post-diagnosis.
Results: Four hundred and eighteen children (258/418 [62%] male; median (IQR) age at diagnosis 13.2 [11.2 – 14.8] years) were included. High-risk phenotype was present in 224/418 (54%) with 53/224 (24%) of high-risk patients not requiring anti-TNF therapy within 18 months of diagnosis. Conversely, 78/194 (40%) of the low-risk group received anti-TNF within 18 months. High-risk patients were more likely to require anti-TNF (171/224 (76%) vs 78/194 (40%), p<0.001) and had shorter median (IQR) time to anti-TNF start (5.0 (1.0 – 8.0) months vs 6.5 (3.3 – 13.0) months, p=0.01).
Conclusions: Our data support the guideline's ability to identify patients more likely to require early treatment escalation. However, this approach would have led to potential over- and under-treatment in a substantial proportion of patients. This underscores the importance of frequent and comprehensive monitoring, along with flexible treatment strategies that adapt to changes in disease status.
| Original language | English |
|---|---|
| Number of pages | 7 |
| Journal | Inflammatory Bowel Diseases |
| Early online date | 13 Dec 2025 |
| DOIs | |
| Publication status | Accepted/In press - 2 Dec 2024 |
Keywords
- Paediatric
- Crohn’s disease
- Anti-TNF