The impact of anti‐TNFα therapy on colectomy rates and corticosteroid treatment among 3001 paediatric and adolescent patients with ulcerative colitis—a nationwide study from 1995 to 2015

Summary Background The long‐term effects of anti‐TNFα therapy in ulcerative colitis are debatable. Aim To examine whether anti‐TNFα therapy changed the colectomy proportion and reduced the use of corticosteroids. Methods A nationwide cohort study among patients (age 0‐20) diagnosed with ulcerative colitis through 1995‐2015 from Danish health registries. We calculated the cumulative 5‐year risk of colectomy after diagnosis and used a Cox regression model for comparison between a historical pre‐anti‐TNFα cohort 1 (1995‐2003) and a cohort 2 for the era of anti‐TNFα (2004‐2015). Based on anti‐TNFα users, defined as patients who had at least four anti‐TNFα treatments within 4 months, we examined the subsequent need for corticosteroids. Results We identified 3001 patients from 1995 to 2015. The 5‐year cumulative proportion of colectomy in cohort 2 was 9.7% (95% confidence interval [CI] 8.4‐11.1) and 12.3% (95% CI 10.4‐14.6) in cohort 1. The adjusted 5‐year hazard ratio (HR) was 0.76 (95% CI 0.60‐0.96) for colectomy in cohort 2 compared to cohort 1. A total of 334 patients received anti‐TNFα treatments, and 16.8% (56/334) were prescribed corticosteroids in the subsequent 3‐month period. Corticosteroid treatment declined with follow‐up after 6 and 12 months, 5.4% and 1.2%, respectively. Conclusion In patient's ≤20 years, the HR for colectomy within a period of 5 years from the time of diagnosis was reduced in the era of anti‐TNFα compared to a historical cohort. In patients treated with anti‐TNFα, prescriptions of corticosteroids were virtually ceased after 12 months.