Michael D. Kappelman

Was not provided for this article.

INTRODUCTION: We examined treatment patterns and clinical outcomes in a contemporary cohort of children with newly diagnosed inflammatory bowel disease (IBD) in a large, commercially insured US population. METHODS: Using the OptumLabs Data Warehouse, we created an inception cohort of physician-diagnosed IBD in children aged 6–17 years between 2007 and 23. We examined cumulative incidence of hospitalization, surgery, safety events, and medication use in patients with Crohn's disease (CD) and ulcerative colitis (UC), overall and stratified by diagnostic era, race and ethnicity, sex, and age at diagnosis. RESULTS: Among 787 children with newly diagnosed CD (age at diagnosis, 13.4 ± 2.9 year; 57% boys; 82% White, 5% Black, 7% Hispanic) followed over mean 4.6 ± 3.0 years, 5-year risk of IBD-related hospitalization and major surgery was 30% and 10%, respectively. In children diagnosed in 2019–23, 1-year cumulative use of corticosteroids and advanced therapy was 46% and 75%, respectively; advanced therapy use increased significantly over time (aHR, 3.43 [95% CI, 2.71–4.32] for 2019–23 vs 2007–12), whereas corticosteroid use declined (0.67 [0.53–0.84]). Risk of IBD-related hospitalization was lower in children diagnosed between 2019 and 23 (0.65 [0.43–0.97]) compared with those diagnosed between 2007–12; surgical risk did not decline significantly, with confidence intervals compatible with a clinically meaningful reduction. Among 399 children with newly diagnosed UC (age at diagnosis, 14.0 ± 3.0 year; 53% boys; 78% White, 5% Black, 7% Hispanic) followed over 4.5 ± 3.0 years, 5-year risk of IBD-related hospitalization and colectomy was 36% and 8%, respectively. Advanced therapy use increased significantly over time (4.46 [2.85–6.98] for 2019–23 vs 2007–12), with no significant change in hospitalization or surgical risk across eras. No consistent racial and ethnic, age, or sex differences in advanced therapy use or clinical outcomes were identified in either CD or UC. DISCUSSION: In a contemporary cohort of commercially insured children with newly diagnosed IBD, early advanced therapy use has increased markedly over time. Surgical risk did not decline significantly in either disease; however, the study was not powered to exclude a clinically meaningful reduction, and these findings are hypothesis-generating rather than conclusive.

INTRODUCTION: The ongoing US measles outbreak raises concerns for immunosuppressed children with inflammatory bowel disease (IBD). METHODS: We evaluated measles seroprotection in pediatric patients with IBD using a high-sensitivity ELISA (Zeus) compared with a standard commercial assay. RESULTS: Among 176 patients, 173 (98%) were seropositive despite 87% being on immunosuppressive therapy. In comparison, only 163 (93%) were seropositive by commercial assay, resulting in a negative predictive value of 23%. DISCUSSION: Children with IBD have high measles seroprotection. A negative commercial result should not be interpreted as lack of seroprotection, highlighting the need for more accurate assays.

Lay Summary: Data derived from our previously published pooled administrative claims database analysis were applied to estimate race-weighted state-specific prevalences of inflammatory bowel diseases in the United States to support public health, clinical, and research initiatives at the state and regional level.

Background: Reductions in blood pressure (BP) control among patients with hypertension were observed early in the COVID‐19 pandemic. The degree to which BP control may have returned to prepandemic levels is unknown. Methods: Individuals aged 18 to 85 years with hypertension from 17 health systems participating in the National Patient‐Centered Clinical Research Network were identified using electronic health record data collected as part of routine care. BP control (percentage of patients whose most recent BP measurement was <140/<90 mm Hg) was estimated in a series of 12‐month rolling measurement periods from 2017 through 2022 (January 1, 2017 through December 31, 2017; April 1, 2017 through March 31, 2018; … January 1, 2022 through December 31, 2022). Differences in average BP control between 2022 (January 1, 2022 through December 31, 2022) and 2019 (January 1, 2019 through December 31, 2019) were estimated overall (adjusted for age, sex, and race and ethnicity) and by race and ethnicity (adjusted for age and sex). Results: Our sample included 1 193 314 persons with hypertension in 2019 (48.9% aged 65–85 years, 52.9% men, 66.2% non‐Hispanic White) and 1 499 418 individuals in 2022 (50.6% aged 65–85 years, 47.1% men, 62.7% non‐Hispanic White). The weighted average BP control dropped from 65.3% in 2019 to 61.8% in 2020 and then partially recovered to 62.6% in 2022 (adjusted mean difference, −2.6 percentage points [95% CI, −5.0 to −0.2]). Non‐Hispanic Asian individuals experienced the largest temporal drop in BP control, declining from 68.4% in 2019 to 63.9% in 2022. Conclusions: BP control was disrupted during the COVID‐19 pandemic and had not fully rebounded to prepandemic levels by the end of 2022. Continued surveillance is needed to determine whether the decline in BP control will persist and will result in future adverse cardiovascular events.

Background: The COVID-19 pandemic exposed differences in health care outcomes, including the prescription of COVID-19 antiviral medications. This analysis aimed to describe prescribing patterns in outpatient COVID-19 treatment and assess factors that contributed to these differences. Methods: A cross-sectional analysis was conducted using electronic health record data from August 2022 through March 2024 from health care institutions participating in PCORnet, ^® the National Patient-Centered Clinical Research Network. Descriptive statistics were used to characterize COVID-19 outpatients eligible for treatment, and regression models were used to calculate adjusted prevalence ratios (aPR) of prescribed COVID-19 outpatient treatment. Interaction terms assessed the interactions between race and ethnicity and the combined comorbidity index (CCI), age and sex, and age and race and ethnicity. Results: Of 1,247,420 patients eligible for COVID-19 treatment, 334,947 (26.9%) were prescribed outpatient treatment. In adjusted analyses, compared with White patients, all other racial and ethnic groups had lower aPR for treatment (aPRs:0.89–0.99), except patients who reported being multiracial (aPR:1.00; 95% CI: 0.93–1.08). Those aged 65–74 were prescribed treatment more often (aPR: 1.13; 95% CI: 1.12–1.13) compared with patients aged 20–49. Patients with a CCI of 1–3 and ≥4 were prescribed treatment less often (aPR: 0.99, 95% CI: 0.97–1.01 and aPR: 0.91, 95% CI: 0.89–0.94, respectively), compared with those with a CCI of ≤0. These differences were sustained when considering the interactions between race and age and race and CCI. Conclusions: We found differences in recommended outpatient treatment by several sociodemographic variables. Addressing COVID-19 prescription barriers is essential to slow preventable differences from unmet COVID-19 outpatient care.

INTRODUCTION: Pediatric inflammatory bowel disease (IBD) guidelines recommend assessing varicella zoster virus (VZV) immunity before immune suppression. We evaluated the sensitivity of the commercial VZV assay relative to the more sensitive glycoprotein (GP) IgG ELISA. METHODS: We evaluated VZV immunity among 176 children with IBD using both commercial and GP ELISA tests. RESULTS: Using GP ELISA, 90% showed VZV immunity vs 69% on commercial assays. Commercial test sensitivity was 77% with 69% false-negative rate and 32% negative predictive value. DISCUSSION: As commercial VZV assays frequently fail to detect existing immunity in children with IBD, vaccination history should be used to assess VZV immunity.

INTRODUCTION: Many patients with chronic pouchitis and Crohn's-like disease of the pouch (CLDP) are treated with biologics; however, the comparative effectiveness of advanced therapies in this population has not been systematically evaluated. We sought to compare the effectiveness of antitumor necrosis factor α (anti-TNF) therapies and ustekinumab in patients with chronic inflammatory conditions of the pouch. METHODS: We conducted a prospective, multicenter, cohort study. We included patients with chronic pouchitis and CLDP initiating treatment with anti-TNF therapies or ustekinumab. The primary outcome was clinical remission at 6 months after induction. We also evaluated clinical remission at 6 months among patients with chronic pouchitis and CLDP separately. RESULTS: Among 132 patients, 106 (80%) had a diagnosis of CLDP and 82 (62%) initiated therapy with ustekinumab. A significantly higher proportion of patients with CLDP treated with ustekinumab were in clinical remission at 6 months as compared with patients treated with anti-TNF therapy (62% vs 40%, P = 0.027); however, there was no significant difference among patients with chronic pouchitis ( P = 0.946). There was no independent statistical significance in the odds of remission at 6 months among patients with CLDP among patients receiving ustekinumab compared with anti-TNF therapy (adjusted odds ratio 1.91, 95% confidence interval 0.69–5.30) after adjusting for presence of a fistula, number of preoperative advanced therapies, and number of advanced therapies after IPAA. DISCUSSION: These data suggest the potential benefit of ustekinumab in patients with CLDP and should prompt future novel effectiveness evaluations in this population.

INTRODUCTION: Advances in medical and surgical therapy have improved the outlook for those affected with Crohn's disease and ulcerative colitis; however, it is unclear whether Americans from marginalized racial and ethnic backgrounds have adequate and equitable access to care for inflammatory bowel disease (IBD). We evaluated the association between race and ethnicity and healthcare utilization in patients diagnosed with inflammatory bowel disease. METHODS: This study identified children and adults diagnosed with IBD in 2 national data sets from 2016 to 2017. We modeled the association between healthcare utilization and racial and ethnic subpopulations across different age groups using generalized estimating equations adjusted by disease and socioeconomic factors. RESULTS: Among working-age adults, Black Americans had higher emergency department admission, hospitalization, and steroid use than White patients; however, these differences were attenuated after adjusting for socioeconomic factors. Asian and Hispanic Americans were less likely to receive outpatient gastroenterological care and medical therapy even after adjustment. Emergency department use was more likely among elderly Black patients. Hispanic children had increased healthcare utilization for IBD compared with White children, although these results did not meet statistical significance. DISCUSSION: Healthcare utilization for long-term management of IBD is lower in historically marginalized racial and ethnic groups compared with White Americans. Further research is needed to identify and address modifiable patient, clinician, and healthcare system barriers to achieve health equity in the management of IBD.

INTRODUCTION: Immune-modifying therapies in pediatric inflammatory bowel disease (IBD) increase infection risks, including varicella. METHODS: Using Optum's deidentified Clinformatics Data Mart Database, a nationwide US commercial insurance claims database (2007–2022), we conducted a retrospective study of 5,368 patients with IBD aged 21 years or younger matched to a non-IBD cohort. The primary outcome was incidence of varicella. RESULTS: Varicella incidence was low in both groups (IBD: 0.570 vs non-IBD: 0.297 per 1,000 person-years, P = 0.23). At year 4, cumulative varicella incidence was 0.27% for IBD and 0.18% for non-IBD (P = 0.24). No hospitalizations or deaths occurred. DISCUSSION: Despite immune-modifying therapy, pediatric patients with IBD demonstrate low varicella incidence.