Center for Pediatric Inflammatory Bowel Disease Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan.
Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan.
J Gastroenterol Hepatol. 2020 Apr;35(4):593-600. doi: 10.1111/jgh.14836. Epub 2019 Nov 14.
Very early-onset inflammatory bowel disease (VEO-IBD), defined as IBD diagnosed before 6 years of age, tends to be refractory to conventional treatment for IBD. However, there have been a few reports about the usage of infliximab for VEO-IBD. This study aimed to evaluate the efficacy and safety of infliximab for VEO-IBD.
Medical records of a cohort of children with VEO-IBD who had received infliximab in a Japanese tertiary children's hospital were retrospectively reviewed for their disease characteristics and clinical course. Subjects were categorized into three groups for the descriptive comparison: ulcerative colitis type (UCT), non-UCT with perianal disease (NUC-PD), and non-UCT without perianal disease (NUC-NPD).
Seventeen VEO-IBD patients (five UCT, five NUC-PD, and seven NUC-NPD) had received infliximab as their first biologic. In the UCT group, infliximab was continued over 54 weeks in two patients, and three eventually required surgery. In contrast, all patients in the NUC-PD and NUC-NPD groups followed up over 54 weeks remained on infliximab, and two of three patients and three of five patients were in remission at week 54, respectively. Infusion reactions occurred in all five UCT, three of five NUC-PD, and two of seven NUC-NPD patients; however, except for two patients with severe reactions, infliximab was continued with premedication and slow infusions.
Infliximab appeared useful for children with VEO-IBD. Children with NUC-PD and NUC-NPD responded better with less infusion reaction compared with that with UCT.
非常早发型炎症性肠病（VEO-IBD）定义为 6 岁前诊断的 IBD，往往对常规 IBD 治疗有抗药性。然而，已经有一些关于英夫利昔单抗用于 VEO-IBD 的报告。本研究旨在评估英夫利昔单抗治疗 VEO-IBD 的疗效和安全性。
回顾性分析了一家日本三级儿童医院接受英夫利昔单抗治疗的 VEO-IBD 患儿的病历，以评估其疾病特征和临床过程。根据疾病类型，将患儿分为溃疡性结肠炎组（UCT）、非 UCT 伴肛周疾病组（NUC-PD）和非 UCT 无肛周疾病组（NUC-NPD）。
17 例 VEO-IBD 患儿（5 例 UCT、5 例 NUC-PD 和 7 例 NUC-NPD）接受英夫利昔单抗作为一线生物制剂治疗。在 UCT 组，2 例患儿持续接受英夫利昔单抗治疗超过 54 周，最终均需手术治疗。相比之下，所有 NUC-PD 和 NUC-NPD 组患儿持续接受英夫利昔单抗治疗超过 54 周，其中 3 例患儿在第 54 周时缓解，5 例患儿中有 3 例缓解。5 例 UCT、3 例 NUC-PD 和 2 例 NUC-NPD 患儿均出现输注反应，但除 2 例患儿出现严重反应外，其余患儿均采用预用药和缓慢输注后继续使用英夫利昔单抗治疗。
英夫利昔单抗似乎对 VEO-IBD 患儿有效。与 UCT 相比，NUC-PD 和 NUC-NPD 患儿的反应更好，输注反应更少。
