A Review of Therapeutic Escalation for Pediatric Patients Admitted for Inflammatory Bowel Disease Flares.

Objectives: The objective was to complete a single hospital quality assessment to characterize the use, safety, and outcomes of the 5 specialty medications (infliximab, adalimumab, tofacitinib, ustekinumab, and vedolizumab) used for the treatment of pediatric inflammatory bowel disease following admission due to a disease flare.

Methods: This was a single-center, retrospective, quality assessment of the current clinical practice. The electronic medical record was queried to identify patients ages 0 to 18 years admitted to our institution during a 2-year period from September 1, 2019, to September 30, 2021, who received infliximab, adalimumab, tofacitinib, ustekinumab, and/or vedolizumab for the treatment of Crohn's disease or ulcerative colitis followed by manual data collection and cohort analysis.

Results: The total population comprised 20 patients during 23 encounters. The biologic-naive group included 12 patients during 12 encounters, 2 of which are also included in the biologic-experienced group, which captured a total of 10 patients during 11 encounters. In the biologic-naive group, infliximab monotherapy comprised the largest percentage of therapy plans across encounters (91.6%), with a statistically significant greater number of readmissions within 6 months of discharge (p = 0.00031). The biologic-experienced cohort had a statistically significant longer duration of intravenous corticosteroid administration (p = 0.016) and a large variety of therapy plans.

Conclusions: The diversity of practice observed within our institution supports the need for guidelines to define standard of therapy or guide selection of second-line therapies based on patient-specific factors.