title: Use of Anti-TNFα Agents and Time to First-time Surgery in Paediatric Patients with Ulcerative Colitis and Crohn's Disease.
abstract: OBJECTIVE
  It is debated whether the need for surgery has changed following introduction of anti-TNFα agents in the treatment of paediatric ulcerative colitis [UC] and Crohn's disease [CD]. We aimed to describe the implementation of anti-TNFα agents in paediatric patients, and the need of first-time surgery before and after introduction of anti-TNFα agents.
  
  
  METHODS
  In the Danish National Patient Registry, we identified incident paediatric patients diagnosed from 1998. We calculated the proportion of patients receiving anti-TNFα agents within 5 years from diagnosis, and the cumulative 5 year proportion of surgery, according to calendar periods of diagnosis.
  
  
  RESULTS
  At the end of our study period [2007 and 2008], 29-41% of CD children were treated with anti-TNFα agents within 5 years, and for UC children 17-19%. In 1278 CD patients, the 5 year cumulative proportions of surgery were 14.6-15.6% for children diagnosed in 1998-2008 and 9.7% (95% confidence interval [CI]: 6.7-13.7) for those diagnosed in 2009-2013. In 1468 UC patients, the cumulative proportion of surgery suggested a decline in patients diagnosed after mid 2005, and the hazard ratio of surgery was 0.64 [95% CI: 0.47-0.86] after the introduction of anti-TNFα agents compared with before. For UC patients diagnosed in 2009-2013, the 5 year cumulative proportion of surgery was 7.6% [95% CI: 5.2-11.2].
  
  
  CONCLUSIONS
  This nationwide study showed an extensive use of anti-TNFα agents at the end of our study period. For UC children, our data suggest a decline in the proportion of surgery in the period of increasing use of anti-TNFα agents.
authors.affiliation: Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, DenmarkC michael.due.larsen@rsyd.dk.
authors.forename: Michael Due
authors.initials: MD
authors.lastname: Larsen
authors.affiliation: Department of Surgical Gastroenterology A, Odense University Hospital, and Research Unit of Surgery, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Qvist
authors.affiliation: Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, DenmarkC.
authors.forename: Jan
authors.initials: J
authors.lastname: Nielsen
authors.affiliation: Department of Medical Gastroenterology S, Odense University Hospital, and Research Unit of Medical Gastroenterology, Institute of Clinical Research, University of Southern Denmark, Odense Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Kjeldsen
authors.affiliation: Hans Christian Andersen Children's Hospital, Odense University Hospital, and Paediatric Research Unit, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Rasmus Gaardskær
authors.initials: RG
authors.lastname: Nielsen
authors.affiliation: Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, DenmarkC.
authors.forename: Bente Mertz
authors.initials: BM
authors.lastname: Nørgård
mesh_terms: D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D003718:Denmark; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007422:Intestines / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Crohn’s disease; anti-TNFα agents; children; epidemiology; inflammatory bowel disease; surgery; ulcerative colitis