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Weidner J, Zoch M, Kern I, Reinecke I, Bathelt F, Manuwald U, Peng Y, Henke E, Rothe U, Kugler J. Predictors of improvement in disease activity in childhood and adolescent Crohn's disease: an analysis of age, localization, initial severity and drug therapy - data from the Saxon Registry for Inflammatory Bowel Disease in Children in Germany (2000-2014). Eur J Pediatr 2024; 183:4363-4377. [PMID: 39096385 DOI: 10.1007/s00431-024-05671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/11/2024] [Accepted: 06/25/2024] [Indexed: 08/05/2024]
Abstract
The escalating worldwide prevalence of Crohn's disease (CD) among children and adolescents, coupled with a trend toward earlier onset, presents significant challenges for healthcare systems. Moreover, the chronicity of this condition imposes substantial individual burdens. Consequently, the principal objective of CD treatment revolves around rapid inducing remission. This study scrutinizes the impact of age, gender, initial disease localization, and therapy on the duration to achieve disease activity amelioration. Data from the Saxon Pediatric IBD Registry in Germany were analyzed over a period of 15 years. In addition to descriptive methods, logistic and linear regression analyses were conducted to identify correlations. Furthermore, survival analyses and Cox regressions were utilized to identify factors influencing the time to improvement in disease activity. These effects were expressed as Hazard Ratios (HR) with 95% confidence intervals. Data on the clinical course of 338 children and adolescents with CD were available in the registry. The analyses showed a significant correlation between a young age of onset and the severity of disease activity. It was evident that treatment with anti-TNF (Infliximab) was associated with a more favorable prognosis in terms of the time required for improvement in disease activity. Similarly, favorable outcomes were observed with the combination therapies of infliximab with enteral nutrition therapy and Infliximab with immunosuppressants.Conclusion: Our analysis of data from the Saxon Pediatric IBD Registry revealed that the timeframe for improvement of disease activity in pediatric Crohn's disease is influenced by several factors. Specifically, patient age, treatment modality, and initial site of inflammation were found to be significant factors. The study provides important findings that underline the need for individualized treatment.
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Affiliation(s)
- Jens Weidner
- Medical Faculty Carl Gustav Carus, Institute for Medical Informatics and Biometry, TU Dresden, Fetscherstrasse 74, Dresden, 01307, Germany.
| | - Michele Zoch
- Medical Faculty Carl Gustav Carus, Institute for Medical Informatics and Biometry, TU Dresden, Fetscherstrasse 74, Dresden, 01307, Germany
| | - Ivana Kern
- Medical Faculty Carl Gustav Carus Department of Health Sciences/Public Health, Institute and Policlinic for Occupational and Social Medicine, TU Dresden, Fetscherstrasse 74, Dresden, 01307, Germany
| | - Ines Reinecke
- Data Integration Center, Center for Medical Informatics, University Hospital Carl Gustav Carus, Fetscherstrasse 74, Dresden, 01307, Germany
| | - Franziska Bathelt
- Thiem- Research GmbH, Carl-Thiem-Klinikum Thiemstr. 111, Cottbus, 03048, Germany
| | - Ulf Manuwald
- University of Applied Sciences Dresden (FH-Dresden), Güntzstr. 1, Dresden, 01069, Germany
| | - Yuan Peng
- Medical Faculty Carl Gustav Carus, Institute for Medical Informatics and Biometry, TU Dresden, Fetscherstrasse 74, Dresden, 01307, Germany
| | - Elisa Henke
- Medical Faculty Carl Gustav Carus, Institute for Medical Informatics and Biometry, TU Dresden, Fetscherstrasse 74, Dresden, 01307, Germany
| | | | - Joachim Kugler
- Medical Faculty Carl Gustav Carus Department of Health Sciences/Public Health, Institute and Policlinic for Occupational and Social Medicine, TU Dresden, Fetscherstrasse 74, Dresden, 01307, Germany
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Khan SM, Tuchman D, Imran A, Lakdawala FM, Mansoor S, Abraham J. A Smooth Transition: Assessing Transition Readiness in Adolescents with Inflammatory Bowel Disease. Dig Dis Sci 2024:10.1007/s10620-024-08484-9. [PMID: 38782855 DOI: 10.1007/s10620-024-08484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Inflammatory Bowel Disease (IBD) is an early onset condition that affects individuals of all ages. Approximately 15%-25% of patients present before the age of 20 years, with peak onset occurring during adolescence. AIMS To evaluate transition readiness among adolescents diagnosed with IBD and identify barriers to transition. METHODS We conducted a cross-sectional study of patients with IBD aged 12-21 years. Patients were stratified by age into three groups: A (12-14 years), B (14-17 years), and C (17 + years). Patients were asked to complete a questionnaire which assessed patient knowledge in three areas of transition: 'Taking Charge,' 'My Health,' and 'Using Health Care.' Fisher's Exact and Chi-Square tests were used to evaluate the associations between age and transition readiness. RESULTS A total of 127 participants (68 males and 59 females) with a mean age of 16.14 years were included. Transition readiness increased with age from 60.7% in Group A to 63.2% and 77.9% in Groups B and C, respectively (p < 0.001). Patient confidence and the importance of transition increased with age, with means of 5.51, 6.17, and 6.94 in Groups A, B, and C (p = 0.02). Patient-reported knowledge of their health condition was > 70%, with no statistical differences between the groups (p = 0.65). Patient knowledge regarding 'Using Health Care' increased from 52% in Group A to 79% in Group C (p < 0.001). The greatest barriers to transitioning were carrying health information for Group A (100%) and obtaining provider referrals for Groups B (75%) and C (51%). CONCLUSION This study demonstrated that transition readiness increases with age in adolescents with IBD.
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Affiliation(s)
- Shahzaib M Khan
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
| | - David Tuchman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Sinai Hospital, Baltimore, USA
| | - Alizeh Imran
- Ziauddin Medical College, Karachi, 75000, Pakistan.
| | | | - Sana Mansoor
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Sinai Hospital, Baltimore, USA
| | - Joseph Abraham
- Department of Pediatrics, Sinai Hospital of Baltimore, Baltimore, USA
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Weidner J, Glauche I, Manuwald U, Kern I, Reinecke I, Bathelt F, Amin M, Dong F, Rothe U, Kugler J. Correlation of Socioeconomic and Environmental Factors With Incidence of Crohn Disease in Children and Adolescents: Systematic Review and Meta-Regression. JMIR Public Health Surveill 2024; 10:e48682. [PMID: 38526534 PMCID: PMC11002755 DOI: 10.2196/48682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The worldwide incidence of Crohn disease (CD) in childhood and adolescence has an increasing trend, with significant differences between different geographic regions and individual countries. This includes an increase in the incidence of CD in countries and geographic regions where CD was not previously prevalent. In response to the increasing incidence, the pediatric care landscape is facing growing challenges. OBJECTIVE This systematic review and meta-analysis were undertaken to comprehensively delineate the incidence rates of CD in pediatric populations across different countries and to explore potential influencing factors. METHODS We performed a systematic review of PubMed and Embase (via Ovid) for studies from January 1, 1970, to December 31, 2019. In addition, a manual search was performed in relevant and previously published reviews. The results were evaluated quantitatively. For this purpose, random effects meta-analyses and meta-regressions were performed to investigate the overall incidence rate and possible factors influencing the incidence. RESULTS A qualitative synthesis of 74 studies was performed, with 72 studies included in the meta-analyses and 52 in the meta-regressions. The results of our meta-analysis showed significant heterogeneity between the individual studies, which cannot be explained by a sample effect alone. Our findings showed geographical differences in incidence rates, which increased with increasing distance from the equator, although no global temporal trend was apparent. The meta-regression analysis also identified geographic location, UV index, and Human Development Index as significant moderators associated with CD incidence. CONCLUSIONS Our results suggest that pediatric CD incidence has increased in many countries since 1970 but varies widely with geographic location, which may pose challenges to the respective health care systems. We identified geographic, environmental, and socioeconomic factors that contribute to the observed heterogeneity in incidence rates. These results can serve as a basis for future research. To this end, implementations of internationally standardized and interoperable registries combined with the dissemination of health data through federated networks based on a common data model, such as the Observational Medical Outcomes Partnership, would be beneficial. This would deepen the understanding of CD and promote evidence-based approaches to preventive and interventional strategies as well as inform public health policies aimed at addressing the increasing burden of CD in children and adolescents. TRIAL REGISTRATION PROSPERO International prospective register of systematic reviews CRD42020168644; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=168644. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-037669.
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Affiliation(s)
- Jens Weidner
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ingmar Glauche
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ulf Manuwald
- Faculty of Applied Social Sciences, University of Applied Sciences (FHD), Dresden, Germany
| | - Ivana Kern
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ines Reinecke
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Franziska Bathelt
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Thiem-Research GmbH, Cottbus, Germany
| | - Makan Amin
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Department for Trauma Surgery and Orthopaedics, Park-Klinik Weissensee, Berlin, Germany
| | - Fan Dong
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | - Joachim Kugler
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Chen B, Zou Z, Zhang X, Xiao D, Li X. Efficacy and safety of adalimumab in pediatric patients with Crohn's disease: A systematic review and meta-analysis. Eur J Clin Pharmacol 2024; 80:395-407. [PMID: 38157000 PMCID: PMC10873464 DOI: 10.1007/s00228-023-03613-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE There is currently no curative treatment for childhood Crohn's disease (CD). This meta-analysis aimed to validate the efficacy and safety of adalimumab (ADA) in pediatric patients with CD. MATERIALS AND METHODS We searched all relevant studies in the PubMed, Web of Science, Embase, and Cochrane Library databases. The primary outcomes were induction (≤ 12 weeks) and maintenance (up to 48 weeks) of remission and response. Secondary outcomes were severe adverse events and opportunistic infections to ADA. The Cochrane bias assessment tool was used to assess the risk of bias in randomized controlled trials. The methodological quality of the single-arm studies was assessed using the methodological index for non-randomized studies tool. RESULTS Ten clinical trials involving a total of 885 patients were included. Results indicated that 59% (95% confidence interval [CI] 39-80%) of the subjects treated with ADA achieved induction of remission, and 60% (95% CI 35-86%) of the subjects treated with ADA achieved induction of response, 57% (95% CI 44-70%) achieved maintenance of remission, and 63% (95% CI 26-69%) achieved maintenance of response. CONCLUSION Current evidence indicates that ADA is effective in children and adolescents with CD and that adverse events vary but are usually not severe. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/ , identifier CRD42023402199.
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Affiliation(s)
- Bin Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610000, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, 610000, China
| | - Zhuan Zou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610000, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, 610000, China
| | - Xiaoyan Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610000, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, 610000, China
| | - Dongqiong Xiao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610000, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, 610000, China
| | - Xihong Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610000, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, 610000, China.
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Weidner J. IBD: Who Knows Best? Dig Dis Sci 2024; 69:324-325. [PMID: 38087128 PMCID: PMC10861626 DOI: 10.1007/s10620-023-08193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/09/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Jens Weidner
- Medical Faculty Carl Gustav Carus, Institute for Medical Informatics and Biometry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
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Stercel V, Lóczi L, Kadenczki O, Nemes É, Nagy B, Hodossy-Takács R, Szabó AÁ, Fagyas M, Kappelmayer J, Szabó T, Bagoly Z. Effect of anti-SARS-CoV-2 BNT162b2 mRNA vaccination on thrombin generation in children with inflammatory bowel disease. Front Immunol 2023; 14:1257072. [PMID: 37965328 PMCID: PMC10642915 DOI: 10.3389/fimmu.2023.1257072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/31/2023] [Indexed: 11/16/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) including Crohn's disease (CD) and ulcerative colitis (UC), are associated with higher thrombotic risk and enhanced thrombin generation (TG) in adults. Despite encouraging data reporting vaccine safety and low IBD flare rates in adults with IBD, vaccine hesitancy was demonstrated to be high in families of children with IBD. We aimed to find out whether TG is increased in children with IBD as compared to healthy controls and whether TG parameters show significant changes following SARS-CoV-2 mRNA vaccination. Patients and methods In this observational case-control study, 38 children with IBD (CD:18, UC: 20) aged 12-18 years and 62 healthy age-and sex-matched children were enrolled. Blood was collected before the first dose and 2-6 weeks after the second dose of BNT162b2 (Pfizer-BioNTech) mRNA vaccine dose. Blood cell counts, fibrinogen, inflammatory markers (hsCRP, ferritin), anti-SARS-CoV-2 antibody levels were investigated, TG assay was carried-out using platelet-poor plasma. Detailed clinical parameters including disease activity scores (PUCAI, PCDAI) were registered pre-and post- vaccination. A guided questionnaire was used to collect data on adverse reactions (AEs) post- vaccination. Results Baseline TG parameters did not differ between patients and controls. Endogenous thrombin potential showed a significant positive correlation with markers of inflammation and with PCDAI. Inflammatory parameters and TG did not increase in patients and controls post-vaccination. Vaccination significantly increased antibody levels in all three investigated groups, but post-vaccination anti-SARS-CoV-2 S IgG/IgM levels were below the 5th percentile value of healthy children in more than one third of patients. Those receiving TNFα inhibitor therapy presented significantly lower SARS-CoV-2 S IgG/IgM levels as compared to patients on other immunosuppressive regimens. Systemic AEs did not differ between patients and controls while lower rate of local symptoms was found post-vaccination in children with IBD. Only 2 IBD flares were detected 2-6 weeks after the second dose of vaccination. Conclusion Our study is the first to support the safety and efficacy of anti-SARS-CoV-2 BNT162b2 vaccination in children with IBD with detailed pre-and post-vaccination laboratory data including TG. Results of this study may further increase confidence and reduce vaccine hesitancy in caretakers of pediatric IBD patients.
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Affiliation(s)
- Vivien Stercel
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Kálmán Laki Doctoral School, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Linda Lóczi
- Kálmán Laki Doctoral School, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Hungarian Research Network (HUN-REN-UD) Cerebrovascular Research Group, Debrecen, Hungary
| | - Orsolya Kadenczki
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Éva Nemes
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Béla Nagy
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Rebeka Hodossy-Takács
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Ádám Szabó
- Kálmán Laki Doctoral School, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklós Fagyas
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - János Kappelmayer
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Szabó
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsa Bagoly
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Hungarian Research Network (HUN-REN-UD) Cerebrovascular Research Group, Debrecen, Hungary
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Hu T, Wang W, Song F, Zhang W, Yang J. Fecal Calprotectin in Predicting Relapse of Inflammatory Bowel Disease in Children and Adolescents: A Meta-Analysis and Systematic Review. Pediatr Ann 2023; 52:e357-e362. [PMID: 37695282 DOI: 10.3928/19382359-20230720-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The application of fecal calprotectin in the relapse of inflammatory bowel disease remains uncertain in children and adolescents. We systematically searched the common databases for eligible studies. Judgment of diagnostic accuracy included pooled sensitivity and specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and pooled area under the receiver operating characteristic curve. Ultimately, a total of 414 participants from six studies were included. The combined sensitivity, specificity, PLR, and NLR with 95% confidence intervals (CIs) were 0.85 (95% CI = 0.65 to 0.79), 0.71 (95% CI = 0.52 to 0.85), 2.95 (95% CI = 1.71 to 5.09), and 0.21 (95% CI = 0.08 to 0.51), respectively. The area under the summary receiver operating characteristic curve was 0.85, and the DOR was 14.14 (95% CI = 4.46 to 44.80). Our study showed that fecal calprotectin as a biomarker to predict the clinical relapse of inflammatory bowel disease during remission in children and adolescents is effective and worth applying. [Pediatr Ann. 2023;52(9):e357-e362.].
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Leiz M, Moon K, Tischler L, de Laffolie J, van den Berg N. First-line treatment for children and adolescents with Crohn‘s disease—an analysis based on health insurance claims data and guidelines. DEUTSCHES ÄRZTEBLATT INTERNATIONAL 2023. [DOI: 10.3238/arztebl.m2022.0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Martinez-Vinson C, Lemoine A, Bouhnik Y, Braithwaite B, Fohlen-Weill A, Addison J. PERFUSE: Non-Interventional Cohort Study of Patients Receiving Infliximab Biosimilar SB2: Results in Pediatric Patients. J Pediatr Gastroenterol Nutr 2023; 76:451-459. [PMID: 36729422 PMCID: PMC10013152 DOI: 10.1097/mpg.0000000000003683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/27/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES PERFUSE is a non-interventional study of 1233 patients [inflammatory rheumatic disease, n = 496; inflammatory bowel disease (IBD), n = 737] receiving infliximab (IFX) biosimilar SB2 therapy. This analysis describes response to treatment and persistence on SB2 for up to 12 months in pediatric IBD patients (n = 126). METHODS Pediatric IBD patients with Crohn disease (CD) or ulcerative colitis (UC), either naïve or switched from originator IFX, who started SB2 in routine practice after September 2017 were eligible. Data were captured for 12 months following SB2 initiation. Disease activity was measured using C-reactive protein (CRP) levels and the Harvey-Bradshaw Index or Pediatric Ulcerative Colitis Activity Index for CD and UC patients, respectively. Body mass index and height z scores were used to assess patient growth between initiation (M0) and month 12 (M12). RESULTS One hundred twenty-six pediatric IBD patients were included (102 CD patients, 51 naïve and 51 switched; 24 UC patients, 9 naïve and 15 switched). Naive patients' disease scores decreased between M0 and M12. CRP measurements also decreased in naïve CD patients. Switched patients' disease scores and CRP levels remained stable between M0 and M12. Height z scores improved significantly over the course of the treatment for all groups except for naïve UC patients. CONCLUSIONS SB2 provides effective disease control for naïve and switched pediatric patients. Clinical remission rates improved in naïve patients and no loss of control was observed in switched patients after 1 year. Growth failure is not observed in IBD patients under SB2 treatment.
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Affiliation(s)
- Christine Martinez-Vinson
- From the Service de Gastroentérologie et Nutrition Pédiatriques, Hôpital Universitaire Robert-Debré, Paris, France
| | - Anaïs Lemoine
- the Service de Nutrition et Gastroentérologie Pédiatriques, Hôpital Trousseau, APHP, Sorbonne Université, Paris, France
| | - Yoram Bouhnik
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly sur Seine, France
| | | | - Audrey Fohlen-Weill
- Biogen France SAS, Gastroenterology & Rhumatologie, Biosimilars, Paris, France
| | - Janet Addison
- Biogen IDEC, Clinical Research, Biosimilars, Maidenhead, UK
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Chen X, Gao Y, Xie J, Hua H, Pan C, Huang J, Jing M, Chen X, Xu C, Gao Y, Li P. Identification of FCN1 as a novel macrophage infiltration-associated biomarker for diagnosis of pediatric inflammatory bowel diseases. J Transl Med 2023; 21:203. [PMID: 36932401 PMCID: PMC10022188 DOI: 10.1186/s12967-023-04038-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/05/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The incidence of pediatric inflammatory bowel disease (PIBD) has been steadily increasing globally. Delayed diagnosis of PIBD increases the risk of complications and contributes to growth retardation. To improve long-term outcomes, there is a pressing need to identify novel markers for early diagnosis of PIBD. METHODS The candidate biomarkers for PIBD were identified from the GSE117993 dataset by two machine learning algorithms, namely LASSO and mSVM-RFE, and externally validated in the GSE126124 dataset and our PIBD cohort. The role of ficolin-1 (FCN1) in PIBD and its association with macrophage infiltration was investigated using the CIBERSORT method and enrichment analysis of the single-cell dataset GSE121380, and further validated using immunoblotting, qRT-PCR, and immunostaining in colon biopsies from PIBD patients, a juvenile murine DSS-induced colitis model, and THP-1-derived macrophages. RESULTS FCN1 showed great diagnostic performance for PIBD in an independent clinical cohort with the AUC of 0.986. FCN1 expression was upregulated in both colorectal biopsies and blood samples from PIBD patients. Functionally, FCN1 was associated with immune-related processes in the colonic mucosa of PIBD patients, and correlated with increased proinflammatory M1 macrophage infiltration. Furthermore, single-cell transcriptome analysis and immunostaining revealed that FCN1 was almost exclusively expressed in macrophages infiltrating the colonic mucosa of PIBD patients, and these FCN1+ macrophages were related to hyper-inflammation. Notably, proinflammatory M1 macrophages derived from THP-1 expressed high levels of FCN1 and IL-1β, and FCN1 overexpression in THP-1-derived macrophages strongly promoted LPS-induced activation of the proinflammatory cytokine IL-1β via the NLRP3-caspase-1 axis. CONCLUSIONS FCN1 is a novel and promising diagnostic biomarker for PIBD. FCN1+ macrophages enriched in the colonic mucosa of PIBD exhibit proinflammatory phenotypes, and FCN1 promotes IL-1β maturation in macrophages via the NLRP3-caspase-1 axis.
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Affiliation(s)
- Xixi Chen
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Yuanqi Gao
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Jinfang Xie
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Huiying Hua
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Chun Pan
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Jiebin Huang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Mengxia Jing
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Xuehua Chen
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Chundi Xu
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China.
| | - Yujing Gao
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, 750004, China.
| | - Pu Li
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China.
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Menze L, Wenzl TG, Pappa A. [KARLOTTA (Kids + Adolescents Research Learning On Tablet Teaching Aachen) - randomized controlled pilot study for the implementation of a digital educational app with game of skill for pediatric patients with inflammatory bowel disease]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:155-163. [PMID: 35672003 DOI: 10.1055/a-1799-9267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Improvement of disease-specific knowledge in pediatric patients with inflammatory bowel disease (IBD) using a digital app and individualized teaching from physician to patient. METHODS We developed an app for Android Software called KARLOTTA (Kids + Adolescents Research Learning On Tablet Teaching Aachen) with a game of skill and IBD questionnaire with visual feedback and high scores. Randomized controlled study as a pilot project with 30 IBD patients, aged 10-18 years. The intervention group used the KARLOTTA app on a tablet before every consultation during a 12-month period. Outcome parameters were an increase in knowledge, changes in quality of life and analysis of the feedback questionnaires for patient and physician. The statistical analysis was carried out with the X2 -test, Mann-Whitney-U test and descriptive analysis. RESULTS KARLOTTA was played 55 times by 14 patients. In all patients (100%) gaps in knowledge could be discovered and specific teaching took place. In the KARLOTTA group, 11 of 14 patients (79%) had an increase in knowledge, in the control group 7 of 15 patients (47%), p-value of 0.08 with the X2 -test. There were no differences in results for quality of life. The app could be used without any problems in 87% of the appointments. CONCLUSIONS The KARLOTTA app reveals individual gaps in knowledge, provides tailor-made physician-patient teaching and can be easily implemented in the outpatient clinic.
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Affiliation(s)
- Lukas Menze
- Klinik für Kinder- und Jugendmedizin, Uniklinik RWTH Aachen, Aachen, Germany
| | - Tobias G Wenzl
- Klinik für Kinder- und Jugendmedizin, Uniklinik RWTH Aachen, Aachen, Germany
| | - Angeliki Pappa
- Klinik für Kinder- und Jugendmedizin, Uniklinik RWTH Aachen, Aachen, Germany
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12
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BARTOŠKA P, PALUCH Z. Treatment of Crohn's disease. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.22.04819-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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13
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Penagini F, Calcaterra V, Dilillo D, Vandoni M, Gianolio L, Gatti A, Rendo G, Giuriato M, Cococcioni L, De Silvestri A, Zuccotti G. Self-Perceived Physical Level and Fitness Performance in Children and Adolescents with Inflammatory Bowel Disease. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091399. [PMID: 36138708 PMCID: PMC9497882 DOI: 10.3390/children9091399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023]
Abstract
Background: Inflammatory bowel disease (IBD) patients show a higher risk of developing metabolic and cardiovascular diseases due to the presence of systemic low-grade chronic inflammation. Exercise can improve cardiovascular fitness and modulate the inflammatory processes. We evaluated the physical activity (PA) level and the fitness performance of children and adolescents with IBD. Patients and methods: We considered 54 pediatric patients with IBD (14.6 ± 2.2; 22 M), including CD (n = 27) UC (n = 24) and IBD unclassified (n = 3), and 70 healthy children. In all children, the Physical Activity Questionnaire (PAQ-C) and the International Fitness Enjoyment Scale were self-reported and recorded. Results: PAQ-C showed significant difference in PA levels in patients with IBD compared to controls (p < 0.001). A decrease in general fitness (p = 0.003), cardiorespiratory fitness (p = 0.002), strength (p = 0.01), speed agility (p = 0.003), and flexibility (p = 0.01) were also detected between patients and controls. Speed agility was related to age (p = 0.02) and BMI z-score (p = 0.01), and flexibility to BMI z-score (p = 0.05). We noted a correlation between PA levels and physician global assessment (p = 0.021) and activity disease severity (p = 0.025). Conclusions: A poorer PA level and poor physical competence were found in patients with IBD compared to healthy children and adolescents. Monitored exercise could provide multiple benefits at both physical and psychological levels.
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Affiliation(s)
- Francesca Penagini
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Dario Dilillo
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Laura Gianolio
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Alessandro Gatti
- Laboratory of Adapted Motor Activity (LAMA), Department of Public health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Giulia Rendo
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Matteo Giuriato
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy
- Faculty of Physical Culture, Unit of Molecular Biology, Department of Health and Natural Sciences, Gdansk University of Physical Education and Sport, 80070 Gdansk, Poland
| | - Lucia Cococcioni
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Annalisa De Silvestri
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milano, Italy
- Correspondence:
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14
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Application of the capture–recapture method to ascertain the completeness of the Saxon pediatric IBD registry in Germany. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01749-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Aim
The incidence of inflammatory bowel disease (IBD) is increasing worldwide. The Saxon Pediatric IBD Registry was founded in 2000 to describe the epidemiology of pediatric IBD in Germany. The aim of this study was to determinate the completeness of this registry for children and adolescents younger than 15 years and to make this approach transparent. Results of this completeness update have broad implications for further scientific publications from the registry dataset.
Method
The capture–recapture method with two data sources was used to ascertain completeness. A second data source was collected in 2019 for the observation period 2008–2014 from all pediatricians, gastroenterologists, and internists working in practices in a predefined region in Saxony, Germany.
Results
A total of 23 patients with IBD were reported who fulfilled the inclusion criteria. One of them was not recorded in the registry. Therefore, the completeness of the registry was estimated at 95.7% (95% CI 90.2–100). Initial analysis of the Saxon Pediatric IBD Registry over the 15-year period 2000–2014 includes 532 patients, 312 (58.6%) male and 220 (41.4%) female. The distribution of single IBD diseases in the registry was as follows: Crohn’s disease 338 patients (63.5%), ulcerative colitis 176 patients (33.1%), and unclassified IBD 18 patients (3.4%). Evaluations by sex and by disease in age groups and by age at onset were tabulated.
Conclusion
This study demonstrates that the completeness level of the Saxon Pediatric IBD Registry is high (95.7%), and thus the epidemiological data of the registry are reliable.
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15
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Bharti S, Bharti M. The Business of T Cell Subsets and Cytokines in the Immunopathogenesis of Inflammatory Bowel Disease. Cureus 2022; 14:e27290. [PMID: 36039239 PMCID: PMC9407026 DOI: 10.7759/cureus.27290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/03/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory disorder and one of the most common inflammatory diseases of gastrointestinal (GI) tract in young adults. It is now equally prevalent in western countries as well as in Asian countries. Recently, there has been an increasing IBD burden in low- to middle-income countries as opposed to the earlier notion of this being a disease of the affluents. It occurs due to a variety of factors, namely, local immune alteration, disruption and inflammation of the mucosa, environmental factors, microbial commensals, and pathogen-induced genetic predisposition or genetic alteration in protective factors, etc. So far, an exact etiopathogenesis of IBD is yet to be completely elucidated. Several recent types of research have emphasized the role of altered innate and humoral immunity in its causation, many of them based on animal models of IBD. Due to the poor understanding of its etiopathogenesis, IBD is still a challenge for the treating clinicians leading to persistent and recurrent disease in many cases. Immune dysregulation in the GI tract incited by various pathogenic stimuli has gained great attention from researchers in the field of IBD. This review focuses on highlighting the role of various T cell subsets, their interplay, and associated cytokines involved in the pathogenesis of IBD along with a short description of genetic as well as other immunological factors. A better understanding of the pathogenic factors and subsequent randomized controlled trials targeting these factors is prudent for better therapeutic approaches for IBD.
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Țiburcă L, Bembea M, Zaha DC, Jurca AD, Vesa CM, Rațiu IA, Jurca CM. The Treatment with Interleukin 17 Inhibitors and Immune-Mediated Inflammatory Diseases. Curr Issues Mol Biol 2022; 44:1851-1866. [PMID: 35678656 PMCID: PMC9164043 DOI: 10.3390/cimb44050127] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 12/29/2022] Open
Abstract
IL-17 inhibitors (IL-17i) are medicines used to treat dermatological and rheumatic diseases They belong to a class of medicines called biological disease-modifying anti-rheumatic drugs (bDMARDs). This class of drugs has had a major impact on the therapy of autoimmune diseases, being much safer and more effective than treatment with small molecules. At the same time, they have highly beneficial effects on skin and joint changes, and their efficacy has been extensively monitored and demonstrated in numerous clinical trials. More and more such drugs are still being discovered today to ensure the best possible treatment of these patients, but more frequently and relatively constantly three agents are used. Two of them (Secukinumab and Ixekizumab) inhibit IL-17A directly, and the third, Brodamulab, inhibits the IL-17A receptor. Although they are extremely effective in the treatment of these diseases, sometimes their administration has been associated with paradoxical effects, i.e., there is an exacerbation of the inflammatory process. Tough, clinical trials of IL-17i have described cases of exacerbation or even onset of inflammatory bowel disease (IBD), such as Crohn's disease and ulcerative colitis, after administration of these drugs in patients previously diagnosed with psoriasis (PS), psoriatic arthritis (PsA), or ankylosing spondylitis (AS). The pathophysiological mechanism of action is not well understood at present. One explanation would be that this hyperreactive inflammatory process would be triggered by Interferon 1 derived from dendritic plasma cells. Even though there are many reports in the recent literature about the role of IL17i in the onset of IBD, conclusions of studies do not converge. Some of them show an increased incidence of IBD in patients treated with IL17i, while some others affirm their safety of them. In the near future we will surely have more data emerging from ongoing meta-analyses regarding safety of use IL17i in patients who are at risk of developing IBD. Clinical and paraclinical evaluation (inflammatory intestinal markers) are carefully advised before recommending treatment with IL-17i and after initiation of treatment, and prospective surveillance by clinical and biomarkers of patients treated with IL-17i is absolutely essential to capture the onset of IBD.
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Affiliation(s)
- Laura Țiburcă
- Faculty of Medicine and Pharmacy, University of Oradea, 1 December 10 Square, 410087 Oradea, Romania; (L.Ț.); (C.M.V.); (I.A.R.); (C.M.J.)
- “Dr. Gavril Curteanu” Clinical Hospital Regional Center of Medical Genetics Bihor, 410469 Oradea, Romania;
| | - Marius Bembea
- “Dr. Gavril Curteanu” Clinical Hospital Regional Center of Medical Genetics Bihor, 410469 Oradea, Romania;
| | - Dana Carmen Zaha
- Faculty of Medicine and Pharmacy, University of Oradea, 1 December 10 Square, 410087 Oradea, Romania; (L.Ț.); (C.M.V.); (I.A.R.); (C.M.J.)
| | - Alexandru Daniel Jurca
- Faculty of Medicine and Pharmacy, University of Oradea, 1 December 10 Square, 410087 Oradea, Romania; (L.Ț.); (C.M.V.); (I.A.R.); (C.M.J.)
| | - Cosmin Mihai Vesa
- Faculty of Medicine and Pharmacy, University of Oradea, 1 December 10 Square, 410087 Oradea, Romania; (L.Ț.); (C.M.V.); (I.A.R.); (C.M.J.)
| | - Ioana Adela Rațiu
- Faculty of Medicine and Pharmacy, University of Oradea, 1 December 10 Square, 410087 Oradea, Romania; (L.Ț.); (C.M.V.); (I.A.R.); (C.M.J.)
| | - Claudia Maria Jurca
- Faculty of Medicine and Pharmacy, University of Oradea, 1 December 10 Square, 410087 Oradea, Romania; (L.Ț.); (C.M.V.); (I.A.R.); (C.M.J.)
- “Dr. Gavril Curteanu” Clinical Hospital Regional Center of Medical Genetics Bihor, 410469 Oradea, Romania;
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Peters S, Cantez S, De Laffolie J. Implementation of exclusive enteral nutrition in pediatric patients with Crohn's disease-results of a survey of CEDATA-GPGE reporting centers. Mol Cell Pediatr 2022; 9:6. [PMID: 35381916 PMCID: PMC8982684 DOI: 10.1186/s40348-022-00139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/17/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Exclusive enteral nutrition (EEN) is the first-line therapy for pediatric-onset Crohn's disease (CD) patients. CEDATA-GPGE® is the largest patient registry for children and adolescents with inflammatory bowel disease (IBD) in Europe, collecting data from over 5000 patients since 2004 in Germany and Austria. Since the application of EEN over 8 weeks is difficult and a high dropout rate is often described, the mode of application including a supporting structure is crucial for success. The aim of this study was to ascertain the variation in the application of EEN across the participating centers and to associate these with the outcome. RESULTS Thirty-one centers responded to the survey (81.6%). 88.5% of CD patients were recommended EEN for induction therapy, 71.8% actually started with EEN, and 22.1% terminated the EEN prematurely. The duration of EEN typically lasted 6 to 8 weeks, and the polymeric formula was mainly used. 80.6% of the clinics added flavorings to the formulas. After EEN, the most preferred diet for maintenance therapy was a healthy, well-balanced diet considering individual intolerances. CONCLUSIONS EEN is widely recommended as an induction therapy by the German and Austrian pediatric gastroenterologists for children and adolescents with CD. However, this questionnaire-based study has shown a wide variation in EEN protocols used by the different pediatric clinics of CEDATA-GPGE®.
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Affiliation(s)
- Sarah Peters
- Institut für Ernährungswissenschaft, Justus-Liebig-Universität, Giessen, Germany.
| | - Serdar Cantez
- Department for General Pediatrics & Neonatology, University Hospital Giessen, Giessen, Germany
| | - Jan De Laffolie
- Department for General Pediatrics & Neonatology, University Hospital Giessen, Giessen, Germany
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18
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Claßen M, de Laffolie J, Claßen M, Schnell A, Sohrabi K, Hoerning A. Significant advantages for first line treatment with TNF-alpha inhibitors in pediatric patients with inflammatory bowel disease - Data from the multicenter CEDATA-GPGE registry study. Front Pediatr 2022; 10:903677. [PMID: 36304532 PMCID: PMC9595023 DOI: 10.3389/fped.2022.903677] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS In recent years, biological agents, such as anti-TNF-α blockers, have been introduced and have shown efficacy in pediatric patients with inflammatory bowel disease (IBD). Here, the prescription mode differentiated into a first/second line application, and efficacy and side effects are evaluated beginning from 2004 until today. METHODS Statistical analyses of the prospective and ongoing CEDATA multicenter registry data from the Society of Pediatric Gastroenterology and Nutrition (GPGE) were performed for patients receiving a biological agent at least once during the period from June 2004 until November 2020 (n = 487). The analyzed parameters were patient demographics, disease extent and behavior, prior or concurrent therapies, duration and outcome of biological therapy, disease-associated complications, drug-related complications, laboratory parameters and treatment response as determined by the Physician's Global Assessment. RESULTS Crohn's disease (CD) was present in 71.5% of patients, and 52% were boys. Patients showed high disease activity when receiving a first-line TNF-α blocker. After 2016, patients who failed to respond to anti-TNF-α induction therapy were treated with off-label biologics (vedolizumab 4.3% and ustekinumab 2.1%). Propensity score matching indicated that patients with CD and higher disease activity benefitted significantly more from early anti-TNF-α therapy. This assessment was based on a clinical evaluation and lab parameters related to inflammation compared to delayed second-line treatment. Additionally, first-line treatment resulted in less treatment failure and fewer extraintestinal manifestations during TNF-α blockade. CONCLUSION First-line treatment with anti-TNF-α drugs is effective and safe. An earlier start significantly reduces the risk of treatment failure and is associated with fewer extraintestinal manifestations during longitudinal follow-up.
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Affiliation(s)
- Merle Claßen
- Clinic for Children and Adolescent Medicine, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Jan de Laffolie
- Abteilung für Allgemeine Pädiatrie und Neonatologie, Justus Liebig University Gießen, Gießen, Germany
| | - Martin Claßen
- Klinik für Kinder- und Jugendmedizin, Klinikum Bremen-Mitte, Bremen, Germany
| | - Alexander Schnell
- Clinic for Children and Adolescent Medicine, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Keywan Sohrabi
- Abteilung für Allgemeine Pädiatrie und Neonatologie, Justus Liebig University Gießen, Gießen, Germany
| | - André Hoerning
- Clinic for Children and Adolescent Medicine, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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19
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Casalegno Garduño R, Däbritz J. New Insights on CD8 + T Cells in Inflammatory Bowel Disease and Therapeutic Approaches. Front Immunol 2021; 12:738762. [PMID: 34707610 PMCID: PMC8542854 DOI: 10.3389/fimmu.2021.738762] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/16/2021] [Indexed: 12/22/2022] Open
Abstract
CD8+ T cells are involved in the pathogenesis of inflammatory bowel disease (IBD), a complex multifactorial chronic disease. Here, we present an overview of the current research with the controversial findings of CD8+ T cell subsets and discuss some possible perspectives on their therapeutic value in IBD. Studies on the role of CD8+ T cells in IBD have contradictory outcomes, which might be related to the heterogeneity of the cells. Recent data suggest that cytotoxic CD8+ T cells (Tc1) and interleukin (IL) 17-producing CD8+ (Tc17) cells contribute to the pathogenesis of IBD. Moreover, subsets of regulatory CD8+ T cells are abundant at sites of inflammation and can exhibit pro-inflammatory features. Some subsets of tissue resident memory CD8+ T cells (Trm) might be immunosuppressant, whereas others might be pro-inflammatory. Lastly, exhausted T cells might indicate a positive outcome for patients. The function and plasticity of different subsets of CD8+ T cells in health and IBD remain to be further investigated in a challenging field due to the limited availability of mucosal samples and adequate controls.
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Affiliation(s)
- Rosaely Casalegno Garduño
- Mucosal Immunology Group, Department of Pediatrics, Rostock University Medical Center, Rostock, Germany
| | - Jan Däbritz
- Mucosal Immunology Group, Department of Pediatrics, Rostock University Medical Center, Rostock, Germany.,Center for Immunobiology, Blizard Institute, The Barts and the London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
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20
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Salvador-Martín S, Melgarejo-Ortuño A, López-Fernández LA. Biomarkers for Optimization and Personalization of Anti-TNFs in Pediatric Inflammatory Bowel Disease. Pharmaceutics 2021; 13:pharmaceutics13111786. [PMID: 34834201 PMCID: PMC8617733 DOI: 10.3390/pharmaceutics13111786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 12/14/2022] Open
Abstract
The use of biological drugs has improved outcomes in pediatric inflammatory bowel disease (IBD). Prediction of the response to biological drugs would be extremely useful in IBD, and even more so in children, who are still growing physically and psychologically. Specific clinical, biochemical, and genetic parameters are considered predictive of response to biological drugs, although few studies have been carried out in children with IBD. In this review, we present current evidence on biological treatments used in pediatric IBD and the available biomarkers of response. We examine demographics, clinical characteristics, biomarkers (genetic, genomic, and cellular), and microbiota.
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Affiliation(s)
- Sara Salvador-Martín
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (S.S.-M.); (A.M.-O.)
| | - Alejandra Melgarejo-Ortuño
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (S.S.-M.); (A.M.-O.)
| | - Luis A. López-Fernández
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (S.S.-M.); (A.M.-O.)
- Spanish Clinical Research Network (SCReN), 28040 Madrid, Spain
- Correspondence:
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21
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Kucharzik T, Koletzko S, Kannengiesser K, Dignass A. Ulcerative Colitis-Diagnostic and Therapeutic Algorithms. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:564-574. [PMID: 33148393 DOI: 10.3238/arztebl.2020.0564] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/05/2020] [Accepted: 07/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ulcerative colitis is a chronic inflammatory bowel disease with an estimated 150 000 patients in Germany alone. METHODS This review is based on publications about current diagnostic and therapeutic strategies for ulcerative colitis that were retrieved by a selective search in PubMed, and on current guidelines. RESULTS The primary goal of treatment is endoscopically confirmed healing of the mucosa. Mesalamine, in various forms of administration, remains the standard treatment for uncomplicated ulcerative colitis. Its superiority over placebo has been confirmed in meta-analyses of randomized, controlled trials. Glucocorticoids are highly effective in the acute treatment of ulcerative colitis, but they should only be used over the short term, because of their marked side effects. Further drugs are available to treat patients with a more complicated disease course of ulcerative colitis, including azathioprine, biological agents, JAK inhibitors (among them TNF antibodies, biosimilars, ustekinumab, vedolizumab, and tofacitinib), and calcineurin inhibitors. Proctocolectomy should be considered in refractory cases, or in the presence of high-grade epithelial dysplasia. Ulcerative colitis beginning in childhood or adolescence is often characterized by rapid progression and frequent comorbidities that make its treatment a special challenge. CONCLUSION A wide variety of drugs are now available for the treatment of ulcerative colitis, enabling the individualized choice of the best treatment for each patient. Regular surveillance colonoscopies to rule out colon carcinoma should be scheduled at intervals that depend on risk stratification.
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Affiliation(s)
- Torsten Kucharzik
- Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lüneburg; Dr. von Hauner Children's Hospital, LMU Klinikum, University of Munich; Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland; Department of Pediatric Gastroenterology, LMU Klinikum, University of Munich; Medical Clinic I, Agaplesion Markus Krankenhaus, Frankfurt/Main
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22
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Ivković L, Hojsak I, Trivić I, Sila S, Hrabač P, Konjik V, Senečić-Čala I, Palčevski G, Despot R, Žaja O, Kolaček S. Incidence and Geographical Variability of Pediatric Inflammatory Bowel Disease in Croatia: Data From the Croatian National Registry for Children With Inflammatory Bowel Disease. Clin Pediatr (Phila) 2020; 59:1182-1190. [PMID: 32674589 DOI: 10.1177/0009922820941202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of this study was to determine the annual incidence and geographic distribution of pediatric inflammatory bowel disease (IBD) in Croatia. This is a prospective, cohort, multicenter observational study based on the data obtained from the Croatian national registry for children with IBD. Children and adolescents younger than 18 years diagnosed with IBD, in time period between June 1, 2016, and May 31, 2017, were recruited. In total, 51 new cases were identified; 19 Crohn's disease, 28 ulcerative colitis, and 8 IBD-unclassified. Male preponderance of all 3 types of the disease was noticed. The median age at diagnosis was 14.8 years. The calculated annual incidence of pediatric IBD per 100 000 persons per year was 7.05 (2.63 for Crohn's disease, 3.87 for ulcerative colitis, and 0.55 for IBD-unclassified). A north to south gradient was observed with almost 2 times higher incidence in the northern region of the country.
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Affiliation(s)
| | - Iva Hojsak
- Children's Hospital Zagreb, Zagreb, Croatia.,University of Zagreb, Zagreb, Croatia.,University J. J. Strossmayer, Osijek, Croatia
| | | | - Sara Sila
- Children's Hospital Zagreb, Zagreb, Croatia
| | | | | | | | | | - Ranka Despot
- University Hospital Center Split, Split, Croatia
| | - Orjena Žaja
- University Hospital Sisters of Mercy, Zagreb, Croatia
| | - Sanja Kolaček
- Children's Hospital Zagreb, Zagreb, Croatia.,University of Zagreb, Zagreb, Croatia
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23
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Arndt H, Hauenstein C, Weber MA, Däbritz J, Bierwirth C. [Imaging of chronic inflammatory bowel diseases in childhood and adolescence : Repetitorium]. Radiologe 2020; 60:1085-1096. [PMID: 33048221 DOI: 10.1007/s00117-020-00755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chronic inflammatory bowel diseases can already occur in childhood and in contrast to affected adults, are more frequently manifested as unspecific symptoms. Therefore, at the time of diagnosis the gastrointestinal tract may already be severely affected. Both the diagnostic methods and the treatment concept, which is ideally carried out by pediatric gastroenterologists, differ from those used in adults. The primary diagnostics mainly include sonography and hydro-magnetic resonance imaging (MRI), whereby each modality offers certain advantages depending on the patient and the examiner but is also subject to limitations in terms of feasibility and evaluation. Imaging diagnostics contribute not only to finding the diagnosis but also to assessing the extent of the disease. They also serve to monitor the course of the disease in terms of treatment response or failure, to assess the activity and to detect and quantify possible complications, such as fistulas or abscesses.
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Affiliation(s)
- H Arndt
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - C Hauenstein
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
| | - M-A Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
| | - J Däbritz
- Kinder- und Jugendklinik, Universitätsmedizin Rostock, Rostock, Deutschland
| | - C Bierwirth
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
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El-Shabrawi MHF, Tarek S, Abou-Zekri M, Meshaal S, Enayet A, Mogahed EA. Hepatobiliary manifestations in children with inflammatory bowel disease: A single-center experience in a low/middle income country. World J Gastrointest Pharmacol Ther 2020; 11:48-58. [PMID: 32844043 PMCID: PMC7416377 DOI: 10.4292/wjgpt.v11.i3.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/28/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There has been a worldwide increase in the reported incidence of inflammatory bowel disease (IBD) in children over the past 2-3 decades. The hepatobiliary (HB) manifestations of IBD have been well-studied in children in industrialized and developed countries but are infrequently reported in low- and middle-income countries (LMIC) such as Egypt.
AIM To determine the prevalence of the HB manifestations in a cohort of Egyptian children with IBD.
METHODS This cross-sectional observational study was carried out over a period of 6 mo (between June 2013 to December 2013) at the Paediatric Hepatology and Gastroenterology Units of Cairo University Children's Hospital, which is the largest paediatric tertiary care centre in the country.
RESULTS The study included 48 patients with confirmed IBD based upon clinical, laboratory, endoscopic and histopathological features, 29 (60.4%) were male. Twenty-four patients (50%) had ulcerative colitis (UC), 11 (22.9%) had Crohn's disease (CD) and 13 (27.1%) had unclassified-IBD (IBD-U), which was formerly known as indeterminate colitis. The mean age of the patients at the time of presentation was 8.14 (± SD 4.02) years and the mean age at the time of study enrolment was 10.16 (± SD 4.19) years. All patients were screened for HB manifestations by physical examination, liver function tests, imaging and liver biopsy when indicated. HB disorders were confirmed in 13 patients (27.1%). Transaminases were elevated in 3 patients (6.3%). Two patients (4.2%) had elevated biliary enzymes (one was diagnosed as primary sclerosing cholangitis (PSC) and the other was diagnosed with PSC/autoimmune hepatitis overlap syndrome and the third patient had hepatitis C virus infection. Ten patients (20.8%) had bright echogenic liver on ultrasound suggesting fatty infiltration as a sequel of malnutrition or medication toxicity.
CONCLUSION The commonest HB disorders in Egyptian children with IBD were abnormal liver function tests, fatty infiltration and PSC. These HB manifestations in paediatric patients in LMIC may be relatively more common than in industrialized countries. Therefore, IBD patients in LMIC should be meticulously screened for liver disease to allow prompt diagnosis and management.
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Affiliation(s)
- Mortada HF El-Shabrawi
- Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Sara Tarek
- Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Maha Abou-Zekri
- Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Safa Meshaal
- Department of Clinical Pathology, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Afaf Enayet
- Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Engy Adel Mogahed
- Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
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25
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Liu Z, Xie W, Li M, Liu J, Liang X, Li T. Intrarectally administered polaprezinc attenuates the development of dextran sodium sulfate-induced ulcerative colitis in mice. Exp Ther Med 2019; 18:4927-4934. [PMID: 31798714 DOI: 10.3892/etm.2019.8155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 09/24/2019] [Indexed: 02/06/2023] Open
Abstract
Polaprezinc (PZ), a chelate of zinc and L-carnosine, has been widely used in the treatment of gastric ulcers since 1994. In recent years, researchers have found PZ to have a beneficial effect on various experimentally induced models of colitis in mice. In the present study, 6% dextran sodium sulfate (DSS) was used to induce a model of ulcerative colitis (UC) in Institute of Cancer Research mice. The therapeutic effect and mechanism of PZ action in a model of UC was studied in order to provide an experimental basis for the clinical application of PZ in UC treatment. The effect of PZ on UC was evaluated in five groups of mice: A vehicle control only group, a DSS model control group (DSS, 6%), a validated treatment control group (DSS 6% + Mesalamine), a low-dose PZ treatment group (DSS 6% + PZ 60 mg/kg) and a high-dose PZ group (DSS 6% + PZ 120 mg/kg). After the animals were sacrificed, blood was collected and the serum levels of NF-κB and tumor necrosis factor-α (TNF-α) were measured. Changes in histology were observed by light microscopy. The protein levels of AKT, phosphorylated AKT and heat shock protein 70 (HSP70) were determined by western blot analysis. The results suggested that PZ reduced the DSS-induced increase in the inflammatory proteins TNF-α and NF-κB in the UC model. The high-dose of PZ also increased the HSP70 protein level, inhibited AKT phosphorylation in a DSS-induced UC animal model, and decreased white blood cell and neutrophil % counts compared to levels in an untreated DSS control group. Histopathology indicated that the mice of the DSS model group had irregular colonic villi, a large number of inflammatory cells and mucosal damage, whereas mice of the group treated with PZ had small intestinal villus morphology and their villi showed signs of recovery from the damage of UC. The results of the present study indicated that PZ significantly alleviates DSS-induced UC in mice, relieves diarrhea, and inhibits the phosphorylation of inflammatory factors and the inflammatory AKT signaling pathway.
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Affiliation(s)
- Zhaoyang Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P.R. China
| | - Wenbo Xie
- Jilin Province Broadwell Pharmaceutical Co., Ltd., Liaoyuan, Jilin 130000, P.R. China
| | - Mingru Li
- Jilin Province Broadwell Pharmaceutical Co., Ltd., Liaoyuan, Jilin 130000, P.R. China
| | - Jing Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P.R. China
| | - Xiao Liang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P.R. China
| | - Tao Li
- Institute of Basic Medical Sciences of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, P.R. China
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Niehues T, Özgür TT. The Efficacy and Evidence-Based Use of Biologics in Children and Adolescents: Using Monoclonal Antibodies and Fusion Proteins as Treatments. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:703-710. [PMID: 31711560 PMCID: PMC6891884 DOI: 10.3238/arztebl.2019.0703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 12/27/2018] [Accepted: 07/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Monoclonal antibodies (mAb) and fusion proteins (FP) are increasingly being used in children and adolescents. In this review, we analyze the evidence for their safety and efficacy in the treatment of the most common chronic inflammatory diseases. METHODS We systematically searched PubMed, AWMF.org, and other databases for high-quality trials (i.e., randomized controlled trials with clinical primary endpoints) and guidelines published at any time up to 10 December 2018 that dealt with mAb and FP that are approved for pediatric use. The search term was "monoclonal anti- body/fusion protein [e. g. adalimumab] AND children." RESULTS The 620 hits included 25 high-quality trials (20 of them manufacturer- sponsored) on 9 mAb/FP (omalizumab, adalimumab, etanercept, ustekinumab, infliximab, golimumab, anakinra, canakinumab, tocilizumab, and abatacept), as well as 6 guidelines (3 each of levels S3 and S2k) on the treatment of bronchial asthma, psoriasis, juvenile idopathic arthritis, and chronic inflammatory bowel diseases. For none of these conditions are mAb and FP the drugs of first choice. Adverse drug effects are rare but sometimes severe (infection, immune dysregulation, tumors). CONCLUSION The retrieved trials have deficiencies that make it difficult to reliably evaluate the efficacy, safety, and utility of mAb/FP for children and adolescents with chronic inflammatory diseases. mAb/FP nonetheless represent a treatment option to be considered in case conventional immune-modulating drugs are ineffective. Researcher-initiated, high-quality trials and manufacturer-independent, systematic long-term evaluations of adverse effects (e.g., tumors) are sorely needed.
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Affiliation(s)
- Tim Niehues
- Department of Pediatrics and Adolescent Medicine, HELIOS Klinikum Krefeld
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Schütz L, Radke M, Menzel S, Däbritz J. Long-term implications of structured transition of adolescents with inflammatory bowel disease into adult health care: a retrospective study. BMC Gastroenterol 2019; 19:128. [PMID: 31324228 PMCID: PMC6642593 DOI: 10.1186/s12876-019-1046-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022] Open
Abstract
Background We aimed to evaluate the long-term clinical and socioeconomic outcome of structured transition care in adolescents with inflammatory bowel disease (IBD). Methods We compared the clinical long-term course of 24 patients with and 11 patients without structured transition care within 24 months before and 24 months after transfer from paediatric to adult health care. Socio-economic parameters and quality of life were assessed by IBD Questionnaire (IBDQ-32) and additional items. Treatment costs were calculated for medication, surgery and hospitalisation. Results The percentage of transfer group patients with an IBD-related intestinal complication was higher compared to the transition group (64% vs. 21%, p = 0.022). We also found a tendency towards a higher number of IBD-related surgery in the transfer group compared to the transition group (46% vs. 13%, p = 0.077). Transfer group patients received higher mean cumulated doses of radiation compared with the transition group (4.2 ± 5.3 mSv vs. 0.01 ± 0.01 mSv, p = 0.036). Delayed puberty was only noted in the transfer group (27%, p = 0.025). Mean expenditures for surgeries and hospitalisation tended to be lower in the transition group compared to transfer group patients (744 ± 630€ vs. 2,691 ± 4,150€, p = 0.050). Sexual life satisfaction was significantly higher (p = 0.023) and rates of loose bowel movements tended to be lower (p = 0.053) in the transition group. Conclusions Structured transition of adolescents with IBD from paediatric into adult health care can lead to important clinical and economic benefits. Electronic supplementary material The online version of this article (10.1186/s12876-019-1046-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lukas Schütz
- Department of Paediatrics, University Hospital Rostock, Ernst-Heydemann-Str. 8, D-18057, Rostock, Germany
| | - Michael Radke
- Department of Paediatrics, University Hospital Rostock, Ernst-Heydemann-Str. 8, D-18057, Rostock, Germany.,Department of Paediatrics, Klinikum Westbrandenburg, Potsdam, Germany
| | - Stephan Menzel
- Ernst-von-Bergmann Outpatient Clinic, Gastroenterology & Hepatology, Potsdam, Germany
| | - Jan Däbritz
- Department of Paediatrics, University Hospital Rostock, Ernst-Heydemann-Str. 8, D-18057, Rostock, Germany.
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Cury DB, Oliveira R, Cury MS. Inflammatory bowel diseases: time of diagnosis, environmental factors, clinical course, and management - a follow-up study in a private inflammatory bowel disease center (2003-2017). J Inflamm Res 2019; 12:127-135. [PMID: 31213873 PMCID: PMC6543909 DOI: 10.2147/jir.s190929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The governmental program of Brazilian Unified National Health System has already published studies on the incidence of inflammatory bowel diseases (IBD), but up until now, there have been no epidemiological studies in private centers in Brazil. However, these diseases tend to affect people from a higher socioeconomic class, mainly in the capital of MS state that has the third highest GDP in Brazil. OBJECTIVES The aim was to analyze an observational, descriptive study of an IBD database in a private center including: the side, behavior of the disease and medical management, the association of extra-intestinal manifestations, and the main clinical symptoms which led to the investigation and diagnosis of IBD. PATIENTS AND METHODS A cohort study was developed in which data of all patients with IBD were analyzed with SPSS software in a constructed electronic database. RESULTS Of 329 patients, 212 (64.4%) had Crohn's disease (CD) and 117 (35.6%) had ulcerative colitis (UC). Average age at diagnosis of CD was 36.19 (±14.33) and of UC was 41.61 (±15.37). An amount of 50.05% of the patients with CD and 72.7% (P<0.001) with UC were female. We have observed that concerning the first symptoms, diahrrea and blood feces corresponded to 70% in UC while in CD 50% of the patients presented diahrrea with blood feces, loss of weight corresponded to 50% and only diahrrea 25%. (P<0.001). Anti-TNFs corresponded to 56.2% being more frequent in CD 0.001%. CD patients used biologic therapy and antibiotics more frequently than those with UC. In conclusion, IBD is also frequent in private health care centers in Brazil; women are most affected. Symptoms such as diarrhea and bleeding, as well as diarrhea and weight loss, must be taken as warning signs to investigate for inflammatory disease. The use of biologic therapies is frequent in referral centers when patients have severe disease.
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Affiliation(s)
- D B Cury
- Inflammatory Bowel Disease Center, Scope Clinic, Campo Grande/MS, Brazil,
| | - R Oliveira
- Biostatistics, UNESP, Botucatu, São Paulo, SP, Brazil
| | - M S Cury
- Advanced Endoscopy Center, Scope Clinic, Campo Grande/MS, Brazil
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Inflammatory Bowel Disease in the Baby to Baby Boomer: Pediatric and Elderly Onset of IBD. ACTA ACUST UNITED AC 2018; 16:289-305. [PMID: 30006766 DOI: 10.1007/s11938-018-0188-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Early- and late-onset of inflammatory bowel disease (IBD) may perhaps be etiologically distinct and potentially attributed to genetics, environmental or microbial factors. We review disease factors and clinical characteristics, as well as unique management and treatment strategies to consider when caring for the "baby" or "baby boomer" with IBD. RECENT FINDINGS Around 25% of cases of initial diagnosis of IBD is made before the age of 18 years old, and another 15-20% made after the age of 60. Crohn's disease (CD) typically presents as ileocolonic and stricturing or penetrating phenotype among early-onset, whereas among late-onset, it is mainly colonic and inflammatory. Pediatric ulcerative colitis (UC) is mostly pan-colonic versus primarily left-sided among the elderly. Treatment goal for both age groups is primarily symptom control, with growth and development also considered among pediatric patients. Due to alterations in pharmacokinetics, careful monitoring and reduced dose should be considered. A multidisciplinary care team is necessary to ensure better clinical outcomes. Onset of disease at either spectrum of age requires careful management and treatment, with both unique disease- and age-appropriate factors carefully considered.
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