Increased prevalence of anti-TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Background: anti-tumour necrosis factor-α (anti-TNF) therapy use has risen in paediatric-onset inflammatory bowel disease (PIBD). Whether this has translated into preventing/delaying childhood surgery is uncertain. The Wessex PIBD cohort were analysed for trends in anti-TNF-therapy and surgery. Design: all patients diagnosed with PIBD within Wessex from 1997-2017 were assessed. Prevalence of anti-TNF-therapy and yearly surgery rates (resection and perianal) during childhood (<18 years) were analysed (Pearson’s correlation, multivariate regression, Fisher’s exact). Results: eight-hundred-and-twenty-five children were included (498 Crohn’s disease, 272 ulcerative colitis, 55 IBD-unclassified), mean age at diagnosis 13.6 years (1.6-17.6), 39.6% female. Prevalence of anti-TNF-treated patients increased from 5.1% to 27.1% (2007-2017), p=0.0001. Surgical resection-rate fell (7.1% to 1.5%, p=0.001), driven by a decrease in Crohn’s disease resections (8.9% to 2.3%, p=0.001). Perianal surgery and ulcerative colitis resection-rates were unchanged. Time from diagnosis to resection increased (1.6 to 2.8 years, p=0.028) but mean age at resection was unchanged. Patients undergoing resections during childhood were diagnosed at a younger age in the most recent five years (2007-2011=13.1 years, 2013-2017=11.9 years, p=0.014). Resection-rate in anti-TNF-therapy treated (16.1%) or untreated (12.2%) was no different (p=0.25). Patients started on anti-TNF-therapy <3 years post-diagnosis (11.6%) vs later (28.6%) had a reduction in resections, p=0.047. Anti-TNF-therapy prevalence was the only significant predictor of resection-rate using multivariate regression (p=0.011). Conclusion: the prevalence of anti-TNF-therapy increased significantly, alongside a decrease in surgical resection-rate. Patients diagnosed at younger ages still underwent surgery during childhood. Anti-TNF-therapy may reduce the need for surgical intervention in childhood, thereby influencing the natural history of PIBD