Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petach-Tikva, Israel.
J Crohns Colitis. 2013 Jun;7(5):369-76. doi: 10.1016/j.crohns.2012.03.006. Epub 2012 Apr 5.
Anti tumor necrosis factor alpha (TNFα) agents have become widely used in pediatric inflammatory bowel disease (IBD). So far, only few studies examined the long-term results of anti-TNFα treatment in children with IBD.
The long-term outcome of pediatric patients with IBD was assessed retrospectively in a multicenter cohort of children treated with anti-TNFα beyond induction treatment. Short- and long-term response rates, predictors for loss of response, data on growth and laboratory parameters were assessed.
120 patients [101 crohn's disease (CD), 19 ulcerative colitis (UC) or indeterminate colitis (IC)] received either infliximab or adalimumab. The mean age at initiation of anti-TNFα was 13.4 ± 3.9 years and the median duration of anti-TNFα treatment was 15 months (range: 2-90). Overall, 89% of the cohort experienced short-term response following induction. Response was associated with improvement in weight and BMI Z-scores (p<0.001) but not with linear growth. Responders experienced a significant decrease in erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) during treatment (p<0.001). Albumin and hemoglobin both improved but only albumin increased significantly (p<0.001). The cumulative probability of losing response to anti-TNFα treatment was 17%, 38%, and 49% after 1, 3, and 5 years, respectively. Responders had a significantly lower weight and BMI Z-scores at initiation of anti-TNFα treatment in compared to non-responders (p=0.04 and 0.02 respectively).
Our long term cohort supports the current evidence on the effectiveness and safety of anti-TNFα treatment in children with IBD. Response to treatment was interestingly associated with lower weight and BMI.
抗肿瘤坏死因子 α（TNFα）药物已广泛应用于儿科炎症性肠病（IBD）。迄今为止，仅有少数研究检查了抗 TNFα 治疗在儿童 IBD 中的长期结果。
通过对接受抗 TNFα 诱导治疗后长期治疗的儿科患者进行多中心队列回顾性研究，评估 IBD 患儿的长期结果。评估短期和长期反应率、反应丧失的预测因素、生长和实验室参数的数据。
120 例患者[101 例克罗恩病（CD）、19 例溃疡性结肠炎（UC）或不确定结肠炎（IC）]接受英夫利昔单抗或阿达木单抗治疗。抗 TNFα 起始年龄的平均年龄为 13.4±3.9 岁，抗 TNFα 治疗的中位数时间为 15 个月（范围：2-90）。总体而言，89%的患者在诱导后有短期反应。反应与体重和 BMI Z 评分的改善相关（p<0.001），但与线性生长无关。反应者在治疗过程中红细胞沉降率（ESR）和 C 反应蛋白（CRP）显著下降（p<0.001）。白蛋白和血红蛋白均改善，但仅白蛋白显著增加（p<0.001）。抗 TNFα 治疗后 1、3 和 5 年，失去反应的累积概率分别为 17%、38%和 49%。与无反应者相比，反应者在开始抗 TNFα 治疗时的体重和 BMI Z 评分明显较低（分别为 p=0.04 和 0.02）。
我们的长期队列支持目前关于抗 TNFα 治疗儿童 IBD 的有效性和安全性的证据。治疗反应与较低的体重和 BMI 相关。
