Treatment with infliximab for pediatric Crohn's disease: Nationwide survey of Japan

被引:9
作者
Hosoi, Kenji [1 ]
Ohtsuka, Yoshikazu [1 ]
Fujii, Tohru [1 ]
Kudo, Takahiro [1 ]
Matsunaga, Nobuaki [1 ]
Tomomasa, Takeshi [4 ]
Tajiri, Hitoshi [5 ]
Kunisaki, Reiko [9 ]
Ishige, Takashi [10 ]
Yamada, Hiroyuki [6 ,7 ]
Arai, Katsuhiro [2 ]
Yoden, Atsushi [8 ]
Ushijima, Kosuke [12 ]
Aomatsu, Tomoki [8 ]
Nagata, Satoru [3 ]
Uchida, Keiichi [13 ]
Takeuchi, Kazuo [11 ]
Shimizu, Toshiaki [1 ]
机构
[1] Juntendo Univ, Dept Pediat & Adolescent Med, Grad Sch Med, Tokyo, Japan
[2] Natl Ctr Child Hlth & Dev, Div Gastroenterol, Tokyo, Japan
[3] Tokyo Womens Med Univ Hosp, Dept Pediat, Tokyo, Japan
[4] PAL Childrens Clin, Gunma, Japan
[5] Osaka Gen Med Ctr, Dept Pediat, Osaka, Japan
[6] Osaka Med Ctr, Dept Pediat Gastroenterol Nutr & Endocrinol, Osaka, Japan
[7] Res Inst Maternal & Child Hlth, Osaka, Japan
[8] Osaka Med Coll, Dept Pediat, Osaka, Japan
[9] Yokohama City Univ, Med Ctr, Inflammatory Bowel Ctr, Yokohama, Kanagawa, Japan
[10] Gunma Univ, Grad Sch Med, Dept Pediat, Maebashi, Gunma, Japan
[11] Gunma Univ, Grad Sch Med, Gen Hlth Support Ctr, Maebashi, Gunma, Japan
[12] Kurume Univ, Med Ctr, Dept Pediat, Kurume, Fukuoka, Japan
[13] Mie Univ, Grad Sch Med, Dept Gastrointestinal & Pediat Surg, Tsu, Mie, Japan
关键词
Crohn's disease; infliximab; surgery; ulcerative colitis; NECROSIS-FACTOR-ALPHA; ANTI-TNF THERAPY; MAINTENANCE INFLIXIMAB; ULCERATIVE-COLITIS; CHILDREN; TERM; DEPENDENCY; INDUCTION; DURATION; EFFICACY;
D O I
10.1111/jgh.13498
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and AimChildhood-onset inflammatory bowel disease (IBD) is characterized by extensive intestinal involvement and rapid early progression. Infliximab (IFX), cyclosporin (CYA), and tacrolimus (FK506) are increasingly used to treat pediatric IBD; however, their long-term effects and adverse events have not been properly investigated in pediatric patients. The aim of this study was to characterize the effects of these biologics and immunomodulators on pediatric IBD patients in Japan. Additionally, we assessed IFX use in pediatric patients with Crohn's disease (CD). MethodsA national survey of IFX, adalimumab, CYA, and FK506 use in pediatric IBD patients (<17years of age) was sent to 683 facilities in Japan from December 2012 to March 2013. Secondary questionnaires were sent to pediatric and adult practitioners with the aim of assessing the effectiveness and safety of IFX for pediatric CD patients. ResultsThe response rate for the primary survey was 61.2% (N=418). Among 871 pediatric CD patients, 284 (31.5%), 24, 4, and 15 received IFX (31.5%), adalimumab, CYA, and FK506, respectively, from 2000 to 2012. According to the secondary survey, extensive colitis (L3, Paris classification) was diagnosed in 69.4% of pediatric CD patients who received IFX. Regarding the effectiveness of IFX in this population, 54.7% (99/181) of patients were in remission, and 42.0% (76/181) were on maintenance therapy. However, 32.0% (58/181) of patients experienced adverse events, and one patient died of septic shock. ConclusionsInfliximab is reasonably safe and effective in pediatric CD patients and should therefore be administered in refractory cases.
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页码:114 / 119
页数:6
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