Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2022; 28(28): 3666-3681
Published online Jul 28, 2022. doi: 10.3748/wjg.v28.i28.3666
How has the disease course of pediatric ulcerative colitis changed throughout the biologics era? A comparison with the IBSEN study
Yiyoung Kwon, Eun Sil Kim, Yon Ho Choe, Mi Jin Kim
Yiyoung Kwon, Yon Ho Choe, Mi Jin Kim, Department of Pediatrics, Samsung Medical Center, Seoul 06351, South Korea
Eun Sil Kim, Department of Pediatrics, Kangbuk Samsung Medical Center, Seoul 03181, South Korea
Author contributions: Kwon Y designed and performed the research and wrote the paper; Kim MJ designed the research and supervised the report; Kim ES and Choe YH designed the research and contributed to the analysis.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Samsung Medical Center (IRB File No. SMC 2020-12-005).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflict of interests to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mi Jin Kim, MD, PhD, Associate Professor, Department of Pediatrics, Samsung Medical Center, Ilwon-ro 81, Gangnam-gu, Seoul 06351, South
Received: September 28, 2021
Peer-review started: September 28, 2021
First decision: November 18, 2021
Revised: November 21, 2021
Accepted: June 30, 2022
Article in press: June 30, 2022
Published online: July 28, 2022
Research background

There are many articles comparing the clinical outcomes of patients treated with biological agents vs those who did not use biological agents, but no studies have compared the disease course of UC by era before and after the introduction of biological agents. The authors assessed how introduction of new treatment altered disease course over time.

Research motivation

The number of large-scale and long-term follow-up studies for pediatric patients with ulcerative colitis (UC) is insufficient. A representative paper dealing with the clinical course of adult UC is the IBSEN study. This paper dealt with the clinical course before the introduction of biological agents. If the use of biological agents in pediatric UC changed the clinical course of UC, it would be helpful in future treatment decisions.

Research objectives

The aim of this study was to compare the clinical course of pediatric UC by era before and after the introduction of biological agents, and to compare them with clinical course curve of the IBSEN study.

Research methods

Infliximab was approved for use in children in October 2012 in Korea. Group A (n = 48) was followed between January 2003 and October 2012, and Group B (n = 62) was followed between November 2012 and October 2020. Endoscopic remission, drug composition, relapse rate, steroid-free period, and the quality of life of the groups were evaluated as outcomes. Clinical course was plotted with the pediatric UC activity index score, and compared to the curve of the IBSEN study.

Research results

Despite a higher rate of pancolitis, patients in Group B had a higher rate of achieving endoscopic remission, longer steroid-free periods and reduced relapse rate. Unlike the clinical course curve of the IBSEN study, we drew one more independent curve (curve 5), and the proportion of the patients in Group B corresponding to curve 1 (remission or mild severity after initial high activity) was higher. In terms of quality of life, the number of hospitalizations and emergency room visits have improved after the introduction of biological agents. Comparison of treatment costs is also an important issue that needs future research.

Research conclusions

The active use of biological agents may change the long-term disease course in moderate to severe pediatric UC. Growth can also be achieved by reducing the use of steroids.

Research perspectives

Because biological agents are an expensive treatment option, whether there is a difference in economic quality of life caused by treatment with biological agents is also an important topic for future research.