Early Infliximab in Crohn’s is associated with decreased intestinal surgery and similar health care costs

Abstract

Background Using Infliximab early in Crohn’s disease can provide a window of opportunity in children for restoration of growth and achievement of puberty. We aimed to compare clinical outcomes and costs of a retrospective pediatric Crohn’s disease (pCD) cohort treated with early use Infliximab (EUI) within 12 months compared with later use Infliximab (LUI). Methods Retrospective review of all children with pCD commenced on Infliximab was undertaken in a tertiary Australian pediatric center. Results pCD progressing to Infliximab was identified in 70 children: 38 (54%) in the EUI cohort versus 32 (46%) in the LUI cohort. Intestinal surgery had a higher risk of occurring in EUI when compared with LUI (2 (5%) versus 9 (28%), HR 5.67 (95% CI 1.21–26.38); p = .027). No patients in EUI underwent intestinal surgery post Infliximab commencement compared with 3 (9%) in LUI (p = .09). Escalation of Infliximab in luminal Crohn’s disease was not significantly different in EUI when compared with LUI (3 (10.3%) versus 9 (39.1%) (p = .1)). EUI was more frequently used than LUI in 2015–2018 (27 (71%) versus 14 (44%)) p = .029, with the inverse occurring in 2010–2014 (11 (29%) versus 18 (56%)). Hospital admissions per person per year in EUI and LUI were 43 (0.23 visits/person/year) versus 84 (0.67 visits/person/year); IRR 2.51 (95% CI 0.9–7.01); p = .078). Health costs were not significantly different between cohorts. Conclusion EUI in pCD is associated with an increased likelihood of being diagnosed in more recent years, less intestinal surgery and a trend toward decreased hospital admissions than LUI.