Clinical outcomes in pediatric inflammatory bowel disease patients: a systematic review of prospective studies

Abstract

Background and aim: We studied response and remission rates in children and adolescents with inflammatory bowel disease whose real-world data were collected prospectively.

Methods: A systematic literature search was performed in MEDLINE, Embase, and the Improve Care Now registry from inception until March 17, 2022. Inclusion criteria were prospective studies with patients < 18 years at diagnosis (M0) and minimum follow-up of 1 year (M12) mentioning disease phenotype and disease activity. Exclusion criteria were (i) reporting disease activity only at diagnosis, (ii) retrospective studies, and (iii) outcome limited to steroid-free remission. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines and the Newcastle-Ottawa scale were applied. Proportions between groups were compared using a chi-square test (α = 0.05).

Results: The search yielded 394 records and 7 inclusions with a sample size ranging from 33 to 390 patients (total population: 888) and a median follow-up of 1-5 years. Proportions of disease activity differed between M0 and M12 (P < 0.0001) with more inactive (χ² = 5.5) and less moderate-to-severe disease (χ² = 23) at M12. Interestingly, disease activity after 1 year did not differ globally (P = 0.53). Proportions of disease activity in Crohn's disease only and limited to Belgium significantly differed from baseline after 5 years (P < 0.0001 for evolution) but not between 1- and 5-year follow-up (P = 0.94).

Conclusions: The few available prospective cohorts reported a significant decrease in disease activity after 1 year, with no global differences. Proportions of disease activity did not differ between 1- and 5-year follow-up in the Belgian Crohn's disease cohort, suggesting stable disease activity.

Keywords: clinical outcomes; epidemiology; inflammatory bowel disease; pediatrics.