Constant Brad D, de Zoeten Edwin F, Weinman Jason P, Albenberg Lindsey, Scott Frank I
Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, 80045, USA.
Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Dig Dis Sci. 2023 Mar;68(3):877-888. doi: 10.1007/s10620-022-07604-7. Epub 2022 Jul 5.
Internally penetrating Crohn's Disease complications, including abscesses and phlegmon, represent a high-risk Crohn's Disease phenotype. Anti-tumor-necrosis-factor-α (Anti-TNF) therapies are effective in treating penetrating Crohn's Disease and early initiation has shown unique benefits. However, timing of anti-TNF initiation in the setting of internally penetrating Crohn's Disease complications is typically heterogenous due to concern over precipitating serious infections. Recent studies demonstrate such an association may not exist.
We aimed to describe the multidisciplinary management of pediatric patients with internally penetrating Crohn's Disease complications, focusing on the utilization and timing of anti-TNF therapy relative to complication resolution and adverse events.
We performed a single-center retrospective cohort study of pediatric patients with internally penetrating Crohn's Disease complications from 2007 to 2021. The safety and effectiveness of anti-TNF therapy initiation prior to complication resolution was assessed by comparing rates of infectious and Crohn's Disease-related adverse events between those who received anti-TNF therapy prior to complication resolution, versus those who did not.
Twenty-one patients with internally penetrating Crohn's Disease complications were identified. 7/21 received anti-TNF therapy prior to complication resolution. Infectious adverse events within 90 days of complication occurred in 0/7 patients initiating anti-TNF therapy prior to complication resolution and 10/14 patients who did not (p = 0.004). Crohn's Disease-related surgeries and hospitalizations within 1 year of complication occurred in 12/20 patients, with similar frequency between groups.
Initiating anti-TNF therapy prior to internally penetrating Crohn's Disease complication resolution may be a safe and effective strategy to improve clinical outcomes.
包括脓肿和蜂窝织炎在内的穿透性克罗恩病并发症代表了一种高危的克罗恩病表型。抗肿瘤坏死因子-α（抗TNF）疗法在治疗穿透性克罗恩病方面有效，早期启动已显示出独特的益处。然而，由于担心引发严重感染，在穿透性克罗恩病并发症情况下启动抗TNF治疗的时机通常存在差异。最近的研究表明这种关联可能不存在。
我们旨在描述患有穿透性克罗恩病并发症的儿科患者的多学科管理，重点关注抗TNF治疗相对于并发症缓解和不良事件的使用情况及时机。
我们对2007年至2021年患有穿透性克罗恩病并发症的儿科患者进行了一项单中心回顾性队列研究。通过比较在并发症缓解之前接受抗TNF治疗的患者与未接受抗TNF治疗的患者之间的感染性和克罗恩病相关不良事件发生率，评估在并发症缓解之前启动抗TNF治疗的安全性和有效性。
确定了21例患有穿透性克罗恩病并发症的患者。21例中有7例在并发症缓解之前接受了抗TNF治疗。在并发症发生后90天内，0/7例在并发症缓解之前启动抗TNF治疗的患者发生了感染性不良事件，而未接受抗TNF治疗的14例患者中有10例发生了感染性不良事件（p = 0.004）。在并发症发生后1年内，20例患者中有12例进行了与克罗恩病相关的手术和住院治疗，两组之间的频率相似。
在穿透性克罗恩病并发症缓解之前启动抗TNF治疗可能是改善临床结局的一种安全有效的策略。
