Time trends of pediatric inflammatory bowel disease in Catalonia from 2011 to 2023. Population-based cohort study.

INTRODUCTION: Data on temporal trends in treatment use in pediatric inflammatory bowel disease (PIBD) are limited. This study aimed to evaluate treatment trends in PIBD in Catalonia and to explore their association with outcomes, including surgery and hospitalization. MATERIAL AND METHODS: We conducted a population-based cohort study including all pediatric patients (<18 years) with IBD included in the Catalan Health Surveillance System, covering a population of more than 7.5 million individuals, between 2011 and 2023 were identified. Exposure to IBD treatments was obtained from electronic dispensation records. Temporal trends in treatment use, surgical procedures, and hospitalization rates were analyzed. Correlation analyses between treatments and outcomes were performed at the population level. RESULTS: The use of salicylates and corticosteroids increased from 18.6% to 24.8% and from 5.2% to 12.3%, respectively. Immunosuppressive treatment increased during the early study period and subsequently declined, with similar rates at baseline and study end (28.3% vs 29.5%). Advanced therapies increased markedly from 27.0% to 41.8%, with infliximab remaining the most frequently prescribed advanced therapy. Surgical rates (ostomies and resections per 1,000 patient-years) fluctuated over time without a consistent trend (p=0.21). Rates of PIBD-related hospitalization decreased from 205.2 to 150.3 per 1,000 patient-years. CONCLUSIONS: Advanced therapies use in PIBD increased substantially over the study period in Catalonia. This trend coincided with a reduction in PIBD-related hospitalization rates, whereas surgical outcomes remained unchanged. This increase occurred concurrently with a reduction in hospitalization rates, whereas no statistically significant linear trend was observed for surgical outcomes.