Gastroenterology and Nutrition Unit, Meyer children's Hospital, Florence.
Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna.
J Pediatr Gastroenterol Nutr. 2021 May 1;72(5):728-735. doi: 10.1097/MPG.0000000000003043.
Mucosal healing (MH) and histological healing (HH) have been recently proposed as a novel treatment target for inflammatory bowel disease (IBD). The aim of the present study was to evaluate real-life achievement of such outcomes in a cohort of pediatric patients with IBD treated with anti-TNF-alpha (ATA) agents.
A retrospective analysis was performed on patients affected by IBD who received ATA and were followed up at two referral centers. Incidence and cumulative rates for MH and HH for each group were calculated.
Of 170 (105 Crohn's disease [CD] and 65 ulcerative colitis [UC]) patients, 78 with CD and 56 with UC underwent endoscopic re-assessment during the study period. MH was achieved by 32 CD (41%) and 30 UC (53.6%) patients; 26 CD (33.3%) and 22 UC (39.3%) patients achieved HH. MH incidence rate was 19.1/1000 and 47/1000 person-months, whereas HH incidence rate was 15.5/1000 and 34.7/1000 person-months for CD and UC, respectively. Remission at the end of induction was associated with higher MH and HH rates (HR: 2.43, P = 0.049 and HR: 2.94, P = 0.046, respectively) in CD. In UC, adalimumab was associated with lower MH and HH rates (HR: 0.16, P = 0.004 and HR: 0.07, P = 0.003).
We reported a real-life experience arising from a large cohort of pediatric IBD who received ATA scheduled treatment. Less than half of patients with CD and only a little >50% of UC patients achieved MH. Microscopical inflammation was observed in 18.8% CD and 26.7% UC patients who achieved MH. Overall, MH and HH rates appear lower compared to previously published data.
黏膜愈合（MH）和组织学愈合（HH）最近被提出作为炎症性肠病（IBD）的一种新的治疗靶点。本研究的目的是评估接受抗 TNF-α（ATA）治疗的 IBD 儿科患者队列中这些结局的真实实现情况。
对在两个转诊中心接受 ATA 治疗并接受随访的 IBD 患者进行回顾性分析。计算每组 MH 和 HH 的发生率和累积率。
在 170 名（105 名克罗恩病 [CD] 和 65 名溃疡性结肠炎 [UC]）患者中，78 名 CD 和 56 名 UC 患者在研究期间接受了内镜再评估。32 名 CD（41%）和 30 名 UC（53.6%）患者实现 MH；26 名 CD（33.3%）和 22 名 UC（39.3%）患者实现 HH。CD 和 UC 的 MH 发生率分别为 19.1/1000 和 47/1000 人-月，HH 发生率分别为 15.5/1000 和 34.7/1000 人-月。诱导结束时的缓解与更高的 MH 和 HH 率相关（CD 的 HR：2.43，P=0.049 和 HR：2.94，P=0.046）。在 UC 中，阿达木单抗与更低的 MH 和 HH 率相关（HR：0.16，P=0.004 和 HR：0.07，P=0.003）。
我们报告了一项来自接受 ATA 计划治疗的大量儿科 IBD 患者队列的真实经验。不到一半的 CD 患者和只有略多于 50%的 UC 患者实现 MH。在实现 MH 的 18.8% CD 和 26.7% UC 患者中观察到显微镜下炎症。总体而言，与之前发表的数据相比，MH 和 HH 率似乎较低。
