%0 Journal Article %T Long-term effectiveness and safety of anti-TNF in pediatric-onset inflammatory bowel diseases: A population-based study %+ Périnatalité et Risques Toxiques - UMR INERIS_I 1 (PERITOX) %+ CHU Amiens-Picardie %+ Laboratoire Traitement du Signal et de l'Image (LTSI) %+ CHU Pontchaillou [Rennes] %+ Institute for Translational Research in Inflammation - U 1286 (INFINITE (Ex-Liric)) %+ Nutrition, Inflammation et axe Microbiote-Intestin-Cerveau (ADEN) %+ Institute for Research and Innovation in Biomedicine (IRIB) %+ UNIROUEN - UFR Santé (UNIROUEN UFR Santé) %+ Service d'Hépato-Gastroentérologie [CHU Rouen] %+ Groupe Hospitalier du Havre Hôpital Jacques Monod (MONTIVILLIERS) (GHH) %+ Service d'Epidémiologie et de Santé Publique [Lille] %+ Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille) %+ CHU Lille %A Fumery, Mathurin %A Dupont, Claire %A Ley, Delphine %A Savoye, Guillaume %A Bertrand, Valérie %A Guillon, Nathalie %A Wils, Pauline %A Gower-Rousseau, Corinne %A Sarter, Helene %A Turck, Dominique %A Leroyer, Ariane %< avec comité de lecture %@ 1590-8658 %J Digestive and Liver Disease %I Elsevier %8 2023-05 %D 2023 %R 10.1016/j.dld.2023.04.017 %K Crohn's disease %K Loss of response %K Primary non-response %K Ulcerative colitis %K anti-TNF %Z Life Sciences [q-bio]/Human health and pathologyJournal articles %X Background: Anti-TNF agents are the first biologic treatment option in inflammatory bowel disease (IBD). The long-term effectiveness of this strategy at the population level is poorly known, particularly in pediatric-onset IBD.Methods: All patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) before the age of 17 between 1988 and 2011 in the EPIMAD population-based registry were followed retrospectively until 2013. Among patients treated with anti-TNF, the cumulative probabilities of anti-TNF failure defined by primary failure, loss of response (LOR) or intolerance were evaluated. Factors associated with anti-TNF failure were investigated by a Cox model.Results: Among a total of 1,007 patients with CD and 337 patients with UC, respectively 481 (48%) and 81 (24%) were treated with anti-TNF. Median age at anti-TNF initiation was 17.4 years (IQR, 15.1-20.9). Median duration of anti-TNF therapy was 20.4 months (IQR, 6.0-59.9). In CD, the probability of failure of 1st line anti-TNF at 1, 3 and 5 years was respectively 30.7%, 51.3% and 61.9% for infliximab and 25.9%, 49.3% and 57.7% for adalimumab (p = 0.740). In UC, the probability of failure of 1st line anti-TNF therapy was respectively 38.4%, 52.3% and 72.7% for infliximab and 12.5% for these 3 timepoints for adalimumab (p = 0.091). The risk of failure was maximal in the first year of treatment and LOR was the main reason for discontinuation. Female gender was associated with LOR (HR, 1.48; 95%CI 1.02-2.14) and with anti-TNF withdrawal for intolerance in CD (HR, 2.31; 95%CI 1.30-4.11) and disease duration (≥ 2 y vs. < 2 y) was associated with LOR in UC (HR, 0.37; 95%CI 0.15-0.94) in multivariate analysis. Sixty-three (13.5%) patients observed adverse events leading to termination of treatment (p = 0.57). No death, cancer or tuberculosis was observed while the patients were under anti-TNF treatment.Conclusion: In a population-based study of pediatric-onset IBD, about 60% in CD and 70% in UC experienced anti-TNF failure within 5 years. Loss of response account for around two-thirds of failure, both for CD and UC. %G English %L hal-04088937 %U https://u-picardie.hal.science/hal-04088937 %~ UNIV-RENNES1 %~ CNRS %~ UNIV-PICARDIE %~ LTSI %~ HL %~ COMUE-NORMANDIE %~ UR1-HAL %~ UR1-MATH-STIC %~ TEST-UR-CSS %~ UNIV-RENNES %~ UNIROUEN %~ UNIV-LILLE %~ UR1-MATH-NUM %~ UR1-BIO-SA %~ U-PICARDIE %~ PERITOX