Increased Effectiveness of Early Therapy With Anti-Tumor Necrosis Factor-α vs an Immunomodulator in Children With Crohn's Disease

被引：219

作者：

Walters, Thomas D. ^{[1
]}

Kim, Mi-Ok ^{[2
]}

Denson, Lee A. ^{[2
]}

Griffiths, Anne M. ^{[1
]}

Dubinsky, Marla ^{[3
]}

Markowitz, James ^{[4
]}

Baldassano, Robert ^{[5
]}

Crandall, Wallace ^{[6
]}

Rosh, Joel ^{[7
]}

Pfefferkorn, Marian ^{[8
]}

Otley, Anthony ^{[9
]}

Heyman, Melvin B. ^{[10
]}

LeLeiko, Neal ^{[11
]}

Baker, Susan ^{[12
]}

Guthery, Stephen L. ^{[13
,14
]}

Evans, Jonathan ^{[15
]}

Ziring, David ^{[16
]}

Kellermayer, Richard ^{[17
]}

Stephens, Michael ^{[18
]}

Mack, David ^{[19
]}

Oliva-Hemker, Maria ^{[20
]}

Patel, Ashish S. ^{[21
]}

Kirschner, Barbara ^{[22
]}

Moulton, Dedrick ^{[23
]}

Cohen, Stanley ^{[24
]}

Kim, Sandra ^{[25
]}

Liu, Chunyan ^{[2
]}

Essers, Jonah ^{[26
]}

Kugathasan, Subra ^{[27
]}

Hyams, Jeffrey S. ^{[28
]}

机构：

[1] Hosp Sick Children, Toronto, ON M5G 1X8, Canada

[2] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA

[3] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA

[4] Cohen Childrens Med Ctr, New Hyde Pk, NY USA

[5] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[6] Nationwide Childrens Hosp, Columbus, OH USA

[7] Goryeb Childrens Hosp, Morristown, NJ USA

[8] James Whitcomb Riley Hosp Children, Indianapolis, IN USA

[9] IWK Hlth Ctr, Halifax, NS, Canada

[10] Univ Calif San Francisco, San Francisco, CA 94143 USA

[11] Hasbro Childrens Hosp, Providence, RI USA

[12] Childrens Hosp, Buffalo, NY 14222 USA

[13] Univ Utah, Salt Lake City, UT USA

[14] Primary Childrens Med Ctr, Salt Lake City, UT 84103 USA

[15] Nemours Childrens Clin, Jacksonville, FL USA

[16] Childrens Hosp Los Angeles, Los Angeles, CA 90027 USA

[17] Baylor Coll Med, Houston, TX 77030 USA

[18] Childrens Hosp Wisconsin, Milwaukee, WI 53201 USA

[19] Childrens Hosp Eastern Ontario, Ottawa, ON K1H 8L1, Canada

[20] Johns HopkinsMed Ctr, Baltimore, MD USA

[21] Texas Childrens Hosp, Dallas, TX USA

[22] Univ Chicago, Chicago, IL 60637 USA

[23] Vanderbilt Childrens Hosp, Nashville, TN USA

[24] Childrens Healthcare, Atlanta, GA USA

[25] Univ N Carolina, Chapel Hill, NC USA

[26] Childrens Hosp, Boston, MA 02115 USA

[27] Emory Univ, Atlanta, GA 30322 USA

[28] Connecticut Childrens Med Ctr, Div Digest Dis Hepatol & Nutr, Hartford, CT 06106 USA

来源：

GASTROENTEROLOGY | 2014年 / 146卷 / 02期

关键词：

Drug; Pediatric IBD; Immune Regulation; Infliximab; NEWLY-DIAGNOSED CHILDREN; INFLIXIMAB THERAPY; GROWTH; 6-MERCAPTOPURINE; ADALIMUMAB; DURATION; MODERATE;

D O I：

10.1053/j.gastro.2013.10.027

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BACKGROUND & AIMS: Standard therapy for children newly diagnosed with Crohn's disease (CD) includes early administration of immunomodulators after initial treatment with corticosteroids. We compared the effectiveness of early (<= 3 mo after diagnosis) treatment with an anti-tumor necrosis factor (TNF)alpha with that of an immunomodulator in attaining clinical remission and facilitating growth of pediatric patients. METHODS: We analyzed data from the RISK study, an observational research program that enrolled patients younger than age 17 diagnosed with inflammatory (nonpenetrating, nonstricturing) CD from 2008 through 2012 at 28 pediatric gastroenterology centers in North America. Patients were managed by physician dictate. From 552 children (median age, 11.8 y; 61% male; 63% with pediatric CD activity index scores >30; and median C-reactive protein level 5.6-fold the upper limit of normal), we used propensity score methodology to identify 68 triads of patients matched for baseline characteristics who were treated with early anti-TNF alpha therapy, early immunomodulator, or no early immunotherapy. We evaluated relationships among therapies, corticosteroid and surgery-free remission (pediatric CD activity index scores, <= 10), and growth at 1 year for 204 children. Treatment after 3 months was a covariate. RESULTS: Early treatment with anti-TNFa was superior to early treatment with an immunomodulator (85.3% vs 60.3% in remission; relative risk, 1.41; 95% confidence interval [CI], 1.14-1.75; P = .0017), whereas early immunomodulator therapy was no different than no early immunotherapy (60.3% vs 54.4% in remission; relative risk, 1.11; 95% CI, 0.83-1.48; P = .49) in achieving remission at 1 year. Accounting for therapy after 3 months, early treatment with anti-TNF alpha remained superior to early treatment with an immunomodulator (relative risk, 1.51; 95% CI, 1.20-1.89; P = .0004), whereas early immunomodulator therapy was no different than no early immunotherapy (relative risk, 1.00; 95% CI, 0.75-1.34; P = .99). The mean height z-score increased compared with baseline only in the early anti-TNF alpha group. CONCLUSIONS: In children newly diagnosed with comparably severe CD, early monotherapy with anti-TNFa produced better overall clinical and growth outcomes at 1 year than early monotherapy with an immunomodulator. Further data will be required to best identify children most likely to benefit from early treatment with anti-TNF alpha therapy.

引用

页码：383 / 391

页数：9

共 23 条

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