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. 2022 Nov;56(10):1453-1459.
doi: 10.1111/apt.17217. Epub 2022 Oct 4.

The inexorable increase of biologic exposure in paediatric inflammatory bowel disease: a Scottish, population-based, longitudinal study

Christopher J Burgess  1   2 , Rebecca Jackson  3 , Iain Chalmers  4 , Richard K Russell  2 , Richard Hansen  5 , Gregor Scott  5 , Paul Henderson  1   2 , David C Wilson  1   2
Affiliations

The inexorable increase of biologic exposure in paediatric inflammatory bowel disease: a Scottish, population-based, longitudinal study

Christopher J Burgess et al. Aliment Pharmacol Ther. 2022 Nov.

Abstract

Background: The use of biologics in paediatric-onset inflammatory bowel disease (PIBD) is rapidly changing.

Aims: To identify the incidence and prevalence of biologic use within Scottish PIBD services, and to describe patient demographics and outcomes for those patients who required escalation of therapy beyond anti-tumour necrosis factor alpha (anti-TNFα) agents METHODS: We captured a nationwide cohort of prospectively identified patients less than 18 years of age with PIBD (A1 phenotype; diagnosed <17 years of age) within paediatric services over a 4.5-year period (1 January 2015-30 June 2019). All patients who received infliximab, adalimumab, vedolizumab or ustekinumab during the study period and/or received their first dose of these biologics were audited retrospectively.

Results: Scotland-wide PIBD-prevalence cases increased from 554 to 644 over the study period. A total of 495 incident new-start biological therapies were commenced on 403 PIBD patients: 295 infliximab (60%), 161 adalimumab (32%), 24 vedolizumab (5%) and 15 ustekunumab (3%). The proportion of new-start biologics changed with infliximab initiation rates decreasing (87%-54%) while adalimumab (13%-31%), vedolizumab (0%-9%) and ustekinumab (0%-6%) all increased. The incidence rate (first dose of new biologic not including biosimilar switch) increased from 6.9% to 8.1% over the study period and point prevalence rates (any biologic use) increased from 20.2% to 43.5% - an average annual percentage increase of 20%. Biosimilar penetration of new-start anti-TNFα agents increased from 3% to 91%. Demographics and outcomes of those patients receiving vedolizumab and ustekinumab were similar.

Conclusions: Complete accrual of Scottish nationwide biologic usage within paediatric services demonstrates a rapidly changing, inexorably increasing PIBD biologics landscape.

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Figures

FIGURE 1
FIGURE 1
Proportion of incident new‐start biologics. IFX, Infliximab; ADA, Adalimumab; VDZ, vedolizumab; UST, ustekinumab.
FIGURE 2
FIGURE 2
Biosimilar penetration anti‐TNFα. IFX, infliximab; ADA, adalimumab.
FIGURE 3
FIGURE 3
Point prevalent rates of biologic use. AAPC, average annual percentage change.
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References

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