Effectiveness of anti-TNFα for Crohn disease: research in a pediatric learning health system
Christopher B Forrest, Wallace V Crandall, L Charles Bailey, Peixin Zhang, Marshall M Joffe, Richard B Colletti, Jeremy Adler, Howard I Baron, James Berman, Fernando del Rosario, Andrew B Grossman, Edward J Hoffenberg, Esther J Israel, Sandra C Kim, Jenifer R Lightdale, Peter A Margolis, Keith Marsolo, Devendra I Mehta, David E Milov, Ashish S Patel, Jeanne Tung, Michael D Kappelman, Christopher B Forrest, Wallace V Crandall, L Charles Bailey, Peixin Zhang, Marshall M Joffe, Richard B Colletti, Jeremy Adler, Howard I Baron, James Berman, Fernando del Rosario, Andrew B Grossman, Edward J Hoffenberg, Esther J Israel, Sandra C Kim, Jenifer R Lightdale, Peter A Margolis, Keith Marsolo, Devendra I Mehta, David E Milov, Ashish S Patel, Jeanne Tung, Michael D Kappelman
Abstract
Objectives: ImproveCareNow (ICN) is the largest pediatric learning health system in the nation and started as a quality improvement collaborative. To test the feasibility and validity of using ICN data for clinical research, we evaluated the effectiveness of anti-tumor necrosis factor-α (anti-TNFα) agents in the management of pediatric Crohn disease (CD).
Methods: Data were collected in 35 pediatric gastroenterology practices (April 2007 to March 2012) and analyzed as a sequence of nonrandomized trials. Patients who had moderate to severe CD were classified as initiators or non-initiators of anti-TNFα therapy. Among 4130 patients who had pediatric CD, 603 were new users and 1211 were receiving anti-TNFα therapy on entry into ICN.
Results: During a 26-week follow-up period, rate ratios obtained from Cox proportional hazards models, adjusting for patient and disease characteristics and concurrent medications, were 1.53 (95% confidence interval [CI], 1.20-1.96) for clinical remission and 1.74 (95% CI, 1.33-2.29) for corticosteroid-free remission. The rate ratio for corticosteroid-free remission was comparable to the estimate produced by the adult SONIC study, which was a randomized controlled trial on the efficacy of anti-TNFα therapy. The number needed to treat was 5.2 (95% CI, 3.4-11.1) for clinical remission and 5.0 (95% CI, 3.4-10.0) for corticosteroid-free remission.
Conclusions: In routine pediatric gastroenterology practice settings, anti-TNFα therapy was effective at achieving clinical and corticosteroid-free remission for patients who had Crohn disease. Using data from the ICN learning health system for the purpose of observational research is feasible and produces valuable new knowledge.
Keywords: Crohn disease; anti-tumor necrosis factor-α; child; comparative effectiveness research.
Copyright © 2014 by the American Academy of Pediatrics.
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Source: PubMed