Efficacy of Combined Initial Treatment of Methotrexate with Infliximab in Pediatric Crohn's Disease: A Pilot Study

BACKGROUND

The combination of antitumor necrosis factor-alpha (TNF-α) agents with immunomodulators (IMMs) is a common treatment for pediatric Crohn's disease (CD). Although methotrexate (MTX) can be a first-line medication as an IMM, most clinicians in real-life practice, especially in South Korea, are more familiar with thiopurines. This study aimed to compare the efficacy and immunogenicity of MTX and azathioprine (AZA) as concurrent therapies for pediatric CD.

METHODS

In this pilot study, 29 newly diagnosed pediatric patients with moderate-to-severe CD were randomized to receive either MTX (n = 15) (15 mg/body surface area (BSA) per week) or oral AZA (n = 14) (0.5 mg/kg per day) in combination with Infliximab (IFX). The primary outcomes were the proportion of patients in endoscopic, biochemical, and transmural remission after 14 and 54 weeks of IFX therapy. The trough levels (TLs) of IFX and anti-drug antibody (ADA) levels were also compared.

RESULTS

Among the 29 patients, there were no significant differences in the biochemical (p = 1.0 at week 14, p = 0.45 at week 54), endoscopic (p = 0.968 at week 14, p = 0.05 at week 54), or transmural (p = 0.103 at week 54) remission rates between the two medications during the concurrent therapy. Additionally, the trends in the IFX trough and ADA levels over time during the treatments were similar for both medications, with no significant differences (p = 0.686, p = 0.389, respectively).

CONCLUSION

The MTX showed comparable efficacy to the AZA in pediatric CD patients with moderate-to-severe disease. This effectively maintained adequate IFX levels and reduced ADA production. Therefore, although additional large-scale clinical trials are needed, this study demonstrated that either MTX or AZA can be selected as IMMs in the concurrent treatment of pediatric CD, depending on individual medical institutions' circumstances.

Comparative Genomic Analysis and Physiological Properties of Limosilactobacillus fermentum SMFM2017-NK2 with Ability to Inflammatory Bowel Disease

The objective of this study was to evaluate the anti-inflammatory effect of Latilactobacillus sakei SMFM2017-NK1 (LS1), L. sakei SMFM2017-NK3 (LS2), and Limosilactobacillus fermentum SMFM2017-NK2 (LF) on colitis using an animal model. DSS (dextran sulfate sodium salt) was orally injected into C57BL/6N mice to induce inflammation in the colon for seven days. Colitis mice models were treated with LS1, LS2, and LF, respectively, and Lacticaseibacillus rhamnosus GG (LGG) was used as a positive control. During oral administration of lactic acid bacteria, the weights of the mice were measured, and the disease activity index (DAI) score was determined by judging the degree of diarrhea and bloody stool. When comparing the differences between the minimum weight after DSS administration and the maximum weight after lactic acid bacteriaadministration were compared, the LF-treated group showed the highest weight gain at 8.91%. The DAI scores of the LF, LS2, and LGG groups were lower than that of the control group. After sacrifice, mRNA expression levels for proinflammatory cytokines (TNF-α, IL-1β, IL-6, and IFN-γ) and mediators (iNOS and COX-2) in the colon were measured. LF was selected as a superior strain for anti-inflammation in the colon. It was further analyzed to determine its biochemical characteristics, cytotoxicity, and thermal stability. Catalase and oxidase activities for LF were negative. In cytotoxicity and heat stability tests, the LF group had higher cell viability than the LGG group. The genome of LF was obtained, and 5682 CDS, 114 tRNA, 2 RNA, and 5 repeat regions were predicted. Especially, LF could be distinguished from the other three L. fermentum strains based on taxonomic profiling, specific orthologous genes of the strain, and genomic variants. The results of this study suggest that L. fermentum SMFM2017-NK2 is a novel strain with an anti-inflammatory effect on colitis.

Medications and the Risk of Colorectal Cancer in Patients with Inflammatory Bowel Diseases: Use of the Landmark Method

PURPOSE

This study aimed to determine whether the use of drugs in the treatment of inflammatory bowel disease is related to the risk of colorectal cancer using a Cox proportional hazards model with the landmark method to minimize immortal time bias.

MATERIALS AND METHODS

This study was conducted as national cohort-based study using data from Korea's Health Insurance Corporation. Newly diagnosed patients with inflammatory bowel disease from 2006 to 2010 were monitored for colorectal cancer until 2015. Hazard ratios and 95% confidence intervals were calculated and compared with the incidence of colorectal cancer with or without medications by applying various landmark points.

RESULTS

In patients with Crohn's disease, the prevention of colorectal cancer in the group exposed to immunomodulators was significant in the basic Cox model; however, the effect was not statistically significant in the model using the landmark method. The preventive effect of 5-aminosalicylic acid in patients with ulcerative colitis was significant in the basic and 6-month landmark point application models, but not in the remaining landmark application models.

CONCLUSION

In patients with inflammatory bowel disease, the preventive effect of drug exposure on colorectal cancer varies depending on the application of the landmark method. Hence, the possibility of immortal time bias should be considered.

Body image, self-esteem, and quality of life in children and adolescents with inflammatory bowel disease in a tertiary hospital in South Korea

PURPOSE

This study aimed to examine body image, self-esteem, and quality of life (QOL) in children and adolescents with inflammatory bowel disease (IBD) and to analyze factors influencing QOL.

METHODS

This descriptive study involved 87 participants at a tertiary hospital aged 10 to 18 years who were diagnosed with IBD. Body image, self-esteem, and QOL were measured. Descriptive analysis, the independent t-test, the Mann-Whitney U test, analysis of variance, Pearson correlation analysis, and stepwise multiple regression were used for data analysis.

RESULTS

The average score was 16.95±3.55 for body image, 31.32±5.25 for self-esteem, and 78.64±15.98 for QOL. Height, weight, hospitalization experience, current symptoms, and consumption of oral steroids showed statistically significant effects on QOL. The most significant predictors of QOL were self-esteem (β=.31, p=.002), body image (β=.28, p=.005), number of symptoms (β=-.25, p=.004), and number of hospitalizations in the last year (β=-.24, p=.004).

CONCLUSION

To improve the QOL of children and adolescents with IBD, it is necessary to evaluate self-esteem, body image, and physical problems. In addition, various intervention strategies to improve self-esteem and body image and to reduce physical discomfort should be developed.

The Impact of Korean Medicine Treatment on the Incidence of Parkinson's Disease in Patients with Inflammatory Bowel Disease: A Nationwide Population-Based Cohort Study in South Korea

We aimed to investigate the association between Korean medicine (KM) treatment and the risk of Parkinson's Disease (PD) in patients with inflammatory bowel disease (IBD) in South Korea. This study analyzed data from the National Health Insurance Service-Senior cohort in South Korea. The 1816 IBD patients enrolled in the analysis comprised 411 who received only conventional treatment (monotherapy group) and 1405 who received both conventional and KM treatments (integrative therapy group). The risk of PD in patients with IBD was significantly lower in the integrative therapy group than in the monotherapy group after adjusting for confounding variables (adjusted hazard ratio (HR), 0.56; 95% confidence interval (CI) = 0.34-0.92). In the mild Charlson Comorbidity Index (CCI) group, the risk of PD in patients with IBD in the integrative therapy group was 0.39 times lower (adjusted HR, 95% CI = 0.20-0.77) than that in the monotherapy group. However, there was no significant difference in the risk of PD in patients with IBD between the integrative therapy and monotherapy groups among individuals with severe CCI (adjusted HR, 0.90; 95% CI = 0.41-1.96). IBD patients are at a decreased risk of PD when they receive integrative therapy. KM treatment may prevent PD in IBD patients.