Jeanne Tung, M.D., discusses a recently published article in Pediatrics about anti-TNF drug therapy and remission rates in pediatric Crohn’s disease. This study was conducting using the ImproveCareNow database.
The ImproveCareNow registry was started in 2006 with the idea of improving care in pediatric GI centers. Mayo Clinic joined ImproveCareNow in 2011 and there are now over 60 participating centers across the United States. When IBD patients visit the doctors office, information about their visit is entered into the central database. This includes information about the type of IBD, medications, blood work, height, weight, and Crohn's activity score. An update is sent to a doctor each month about their IBD patients, including an alert if a patient isn't doing well. This can include if a patient isn't in remission, still on steroids, or if a drug dose isn't quite correct.
For the purposes of this study, the researchers look at patients in the database who had Crohn's disease, had moderate to severe activity, started on Remicade or Humira, and had been followed for at least one year in the registry. The researchers were able to identify 603 patients. The identified patients were compared to patients receiving Azathioprine, 6-Mercaptopurine, or Methotrexate.
Using this registry, mock clinical trials were created. The researchers calculated whether patients went into remission and whether they were able to stop steroids. The calculations were based on their Crohn's disease activity. The results found that more patients taking Remicade or Humira were in remission compared to those on Azathoprine, 6-Meraptopurine, or Methotrexate. To be exact, in six months remission was achieved in 54% of patients on anti-TNF agents compared to 41%. In 12 months, remission was achieved in 67% of patients on anti-TNF medication compared to 56%. These results were similar to clinical trial results for adult and children on Remicade.
The results show anti-TNF medication is better for pediatric IBD patients than Methotrexate in inducing remission. This study indicates that using the ImproveCareNow database can be helpful in answering other medication questions.
Clinical trials are still important. In this study, the researchers didn't examine how patients were growing, didn't include blood work to verify remission, and didn't conduct a colonoscopy to verify the tissue was in remission.
Read the full study online here.
For more information on IBD, visit mayoclinic.org/ibd.
Dr. Tung is a pediatric gastroenterologist at Mayo Clinic.