Virta Lauri J, Kolho Kaija-Leena
Research Department, The Social Insurance Institution (Kela), 20720 Turku, Finland.
ISRN Gastroenterol. 2012;2012:462642. doi: 10.5402/2012/462642. Epub 2012 Aug 16.
Objective. There are limited data on the changes of treatment strategies of disease-modifying drugs used to treat pediatric inflammatory bowel disease (IBD). Methods. We utilized data from two national registers: the Drug Reimbursement Register for drug costs (for identifying children with IBD) and the Drug Purchase Register (for exposure to drugs), both of which are maintained by the Social Insurance Institution of Finland. The frequencies and trends of drug therapy strategies during the first year of pediatric IBD were evaluated between 1999 and 2009. Results. A total of 481 children diagnosed with IBD were identified. During the first six months, 68% of the patients purchased systemic corticosteroids; these combined with 5-aminosalicylic acid in almost all cases. The use of corticosteroids was stable from the early years compared with the end of the study period. In Crohn's disease, there was a trend towards more active use of azathioprine: the therapy was introduced earlier and proportion of pediatric patients purchasing azathioprine increased by up to 51% (P < 0.05). Conclusions. In pediatric IBD, the majority of patients purchased corticosteroid within the first six months, reflecting moderate-to-severe disease. During recent years in pediatric Crohn's disease, the therapeutic strategies of oral medication have changed towards more active immunosuppression with azathioprine.
目的。关于用于治疗儿童炎症性肠病（IBD）的病情缓解药物治疗策略变化的数据有限。方法。我们利用了两个国家登记处的数据：用于药物成本的药品报销登记处（用于识别IBD患儿）和药品采购登记处（用于药物暴露情况），这两个登记处均由芬兰社会保险机构维护。评估了1999年至2009年期间儿童IBD第一年的药物治疗策略的频率和趋势。结果。共识别出481名被诊断为IBD的儿童。在最初的六个月里，68%的患者购买了全身用皮质类固醇；几乎所有病例中这些药物都与5-氨基水杨酸联合使用。与研究期末相比，早年皮质类固醇的使用情况较为稳定。在克罗恩病中，硫唑嘌呤的使用有更积极的趋势：该治疗更早开始，购买硫唑嘌呤的儿科患者比例增加了高达51%（P<0.05）。结论。在儿童IBD中，大多数患者在最初六个月内购买了皮质类固醇，这反映了疾病的中重度程度。近年来在儿童克罗恩病中，口服药物的治疗策略已转向使用硫唑嘌呤进行更积极的免疫抑制。
