Increasing Biologic Use in Children With Crohn Disease May Improve Outcomes

More children with Crohn disease have been receiving biologic therapy over the years, and biologics have been associated with a reduced risk for disease complications.

Use of biologic therapy is associated with a 66% decreased risk for complications in pediatric patients with Crohn disease (CD), according to study results presented at the Advances in Inflammatory Bowel Diseases (AIBD) 2022 conference, held from December 5 to 7, 2022, in Orlando, Florida.

Researchers sought to evaluate trends in biologic use over time and the associations between biologic use and the risk for disease complications in CD.

Study participants were from the ImproveCareNow (ICN) network registry and had enrolled 90 days or less after being diagnosed with CD, had complete phenotype information available, and had at least 3 visits.

The primary outcome was composite complications, which included internal penetrating and perianal fistula complications and strictures. Data regarding the use of corticosteroids and immunomodulators were obtained before first biologic use.

A total of 4035 children (mean [SD] age, 12.8[3.4] years; White, 75%; male, 60.2%) with CD were included, with an average follow-up of 1323[749] days. Among the cohort, 68.6% of the participants initiated a biologic, and the first biologic used was infliximab (65.3%), adalimumab (32.4%), and less than 1% each for others. The median time from diagnosis to initiation of a biologic was 119 days (IQR, 34-392).

Despite these improvements, disease complications remain higher among Black patients and those initially treated with steroids and immunomodulators.

Complications occurred in 20.8% of patients, including strictures (9%), internal penetrating complications (5.6%), and perianal fistulizing complications (12.2%). Regarding race, 27.5% of Black patients and 20.2% of White patients had composite complications. Also, 26.1% of those who used immunomodulators and 24.9% of those who used steroids had composite complications.

For patients who initiated biologic therapy, 8.1% had a stricture vs 11% of nonbiologic users (P =.0003). Internal penetrating complications occurred in 4.5% of biologic users and in 7.9% of biologic nonusers (P <.0001), and perianal fistulizing complications were observed in 9.4% of biologic users and in 18.6% of biologic nonusers (P <.0001).

The percentage of newly diagnosed patients per year who initiated biologics increased from 53% in 2010 to 79% in 2019, and the time to initiation decreased from a median of 978 days to 52 days. In the same period, the proportion of participants who had a composite complication was reduced from 24% to 10.4%. A reduction in composite complications also was observed in Black patients (56%-15%) and White patients (19%-10%).

The initiation of biologics was associated with a 66% lower risk for composite complications (hazard ratio [HR], 0.34; 95% CI, 0.29-0.40) and younger age (age <6 years [HR, 0.36; 95% CI, 0.21-0.59]; ages 6 to <10 years [HR, 0.67; 95% CI, 0.55-0.82] vs ages 10-17 years), according to multivariate Cox regression analysis. Black race (HR, 1.61; 95% CI, 1.31-1.98 vs White race), corticosteroid use (HR, 1.44; 95% CI, 1.16-1.78), and immunomodulator use (HR, 1.47; 95% CI, 1.2-1.81) were associated with an increased risk for composite complications.

“These findings indicate that increasing biologic use is associated with improved outcomes,” the study authors wrote. “Despite these improvements, disease complications remain higher among Black patients and those initially treated with steroids and immunomodulators. Strategies are needed to improve outcomes for all patients with CD.”


Lin CC, Gadepalli S, Adler J. Changing use of biologic medications and associated outcomes for pediatric inflammatory bowel disease. Abstract presented at: AIBD 2022; December 5-7, 2022; Orlando, FL. Abstract 59.