Efficacy of early biologic therapy versus late/conventional therapy in children and adolescents with Crohn’s disease: A systematic review and meta-analysis

BACKGROUND: The objective of this study was to estimate the effectiveness of early biologics compared to conventional treatment in the management of Crohn’s disease among pediatric and adolescent patients. METHODS: A comprehensive literature search was conducted in four electronic databases to identify relevant studies published from inception to 2023. The inclusion criteria comprised randomized controlled trials (RCTs) and cohort studies that reported on the efficacy and clinical outcomes of early biologic therapy compared to late/conventional therapy in children with Crohn’s disease. The quality of the studies was assessed using the Cochrane Risk of Bias tool and the Newcastle Ottawa scale. RESULTS: A total of 13 studies (2 RCTs and 11 cohort studies), involving 861 patients, were included in the meta-analysis. The results demonstrated that early biologic therapy was associated with a significantly higher rate of clinical remission (risk ratio [RR] 1.30, 95% confidence interval [CI] 1.10–1.54), lower relapse rates (RR 0.33, 95% CI 0.21–0.53), and improved mucosal healing (RR 1.47, 95% CI 1.10–1.97) compared to late/conventional therapy. However, it should be noted that there was evidence of publication bias among studies reporting clinical remission. CONCLUSION: In conclusion, early biologic therapy is significantly more effective in achieving clinical remission (within two years of diagnosis), promoting mucosal healing, and reducing relapse rates in pediatric and adolescent patients with Crohn’s disease, compared to late/conventional therapy. These findings emphasize the importance of initiating biological therapy early in the treatment of Crohn’s disease in this patient population.