Many physicians hesitate to recommend anti–tumor necrosis factor (TNF) therapy for pediatric patients with inflammatory bowel disease (IBD) because of concerns about risk of infection and cancer.
Dr Corey Siege and colleagues from New Hampshire, USA performed a systematic review to quantify the incidence of serious infection, lymphoma, and death among pediatric patients with IBD who received anti-TNF therapy.
These values were compared with those expected from other treatments, from adults with IBD, and from the general pediatric population.
The research team searched MEDLINE, EMBASE, the Cochrane Collaboration, and Web of Knowledge for studies of infliximab therapy for children with ulcerative colitis or Crohn's disease, or adalimumab therapy for children with Crohn's disease.
Standardized incidence ratios (SIRs) were calculated, comparing rates of infection and cancer among pediatric patients exposed to anti-TNF agents vs expected rates from pediatric patients not exposed to anti-TNF therapies or adult patients exposed to anti-TNF agents.
|2 patients developed lymphoma|
|Clinical Gastroenterology & Hepatology|
The team evaluated 5528 patients with 9516 patient-years of follow-up evaluation (PYF).
The researchers found that the rate of serious infections among pediatric patients treated with anti-TNF agents was similar to that of pediatric patients who received immunomodulator monotherapy.
However, this was significantly lower than the expected rate for pediatric patients treated with steroids or adults treated with anti-TNF agents.
The team observed that 5 treatment-related deaths occurred.
The team noted that 2 patients developed lymphoma.
This value was similar to the expected rate of lymphoid neoplasia in the entire pediatric population, and lower than the population of pediatric patients receiving thiopurine monotherapy, and among adults treated with anti-TNF agents.
Dr Siege's team concludes, "Based on a systematic review, the risk of lymphoma was no greater among children with IBD who received anti-TNF therapy than those treated with other IBD therapies or adults treated with anti-TNF agents."
"The rate of serious infection was significantly lower among pediatric patients with IBD treated with anti-TNF agents than those treated with steroids, or adults with IBD who received anti-TNF therapy."