Guilcher Katharina, Fournier Nicolas, Schoepfer Alain, Schibli Susanne, Spalinger Johannes, Braegger Christian, Nydegger Andreas
Division of Pediatric Gastroenterology.
Institute of Social and Preventive Medicine.
Eur J Gastroenterol Hepatol. 2018 Oct;30(10):1159-1167. doi: 10.1097/MEG.0000000000001197.
During the past decade, several new drugs were approved for the treatment of pediatric inflammatory bowel disease (IBD). We aimed to evaluate if and how pharmacologic treatment options for pediatric IBD in Switzerland have changed over time.
Data from the pediatric Swiss IBD Cohort Study, a national prospective cohort study initiated in 2006, were analyzed. Patients were divided into two groups: patients with IBD diagnosis until 2009 (168 patients) and patients with IBD diagnosis in 2010 and after (210 patients). Both groups were analyzed regarding the past and the current therapies as well as need for surgery.
Overall, 378 pediatric patients with IBD were analyzed, of which 51.9% had Crohn's disease (CD) and 48.1% had ulcerative colitis/indeterminate colitis. Median age at diagnosis was 12 years. The majority (65.4%) of the patients with ulcerative colitis experienced pancolitis, whereas 45.4% of patients with CD presented with ileocolonic disease at diagnosis. A decreased use of corticosteroids in pediatric patients with CD can be found after 2010 (P=0.041). Use of 5-aminosalicylic acid for patients with CD was dramatically reduced after the year 2010 (33.5 vs. 67.7% after 6 years of disease). A significant shift toward earlier use of biologicals could be shown after 2010 (P<0.001). However, there was no significant decrease of surgery rate after 5 years of disease.
In the past decade, a significant earlier use of anti-tumor necrosis factor-α agents in pediatric patients with IBD was observed with steroid-sparing effect in patients with CD. However, this change was not associated with reduction of surgery.
在过去十年中，几种新药被批准用于治疗儿童炎症性肠病（IBD）。我们旨在评估瑞士儿童IBD的药物治疗选择是否以及如何随时间发生变化。
分析了瑞士儿童IBD队列研究的数据，该研究于2006年启动，是一项全国性前瞻性队列研究。患者分为两组：2009年之前诊断为IBD的患者（168例）和2010年及之后诊断为IBD的患者（210例）。对两组患者过去和当前的治疗方法以及手术需求进行了分析。
总体而言，分析了378例儿童IBD患者，其中51.9%患有克罗恩病（CD），48.1%患有溃疡性结肠炎/不确定性结肠炎。诊断时的中位年龄为12岁。大多数（65.4%）溃疡性结肠炎患者患有全结肠炎，而45.4%的CD患者在诊断时表现为回结肠疾病。2010年后，CD患儿使用皮质类固醇的情况有所减少（P = 0.041）。2010年后，CD患者使用5-氨基水杨酸的情况大幅减少（患病6年后分别为33.5%和67.7%）。2010年后，可观察到生物制剂的使用明显提前（P < 0.001）。然而，患病5年后手术率没有显著下降。
在过去十年中，观察到IBD患儿显著更早使用抗肿瘤坏死因子-α药物，对CD患者有类固醇节省效应。然而，这种变化与手术减少无关。
