A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn's disease

Markowitz, James; Grancher, K; Kohn, Nina; Lesser, Martin; Daum, Fredric

doi:10.1053/gast.2000.18144

Cited by 700 publications

(491 citation statements)

References 31 publications

(32 reference statements)

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“…For IBD patients, early diagnosis and aggressive intervention may reduce the possibility of complications (13) and significant delays in evaluation may therefore, lead to poorer outcomes (14) and an impaired quality of life (15). Constipation and diarrhea are also associated with significant impairment of quality of life (16)(17)(18), and delays in diagnosis and therapy are likely to impose a considerable burden on the individual and on society (3).…”

Section: Discussionmentioning

confidence: 99%

Access to Specialist Gastroenterology Care in Canada: Comparison of Wait Times and Consensus Targets

Leddin

Armstrong²,

Barkun³

et al. 2008

Canadian Journal of Gastroenterology

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BACKGROUND: Monitoring wait times and defining targets for care have been advocated to improve health care delivery related to cancer, heart, diagnostic imaging, joint replacements and sight restoration. There are few data on access to care for digestive diseases, although they pose a greater economic burden than cancer or heart disease in Canada. The present study compared wait times for specialist gastroenterology care with recent, evidence-based, consensus-defined benchmark wait times for a range of digestive diseases. METHODS: Total wait times from primary care referral to investigation were measured for seven digestive disease indications by using the Practice Audit in Gastroenterology program, and were benchmarked against consensus recommendations. . DISCUSSION: Total wait times for the seven indications exceeded the consensus targets; 51% to 88% of patients were not seen within the target wait time. Multiple interventions, including adoption of evidence-based management guidelines and provision of economic and human resources, are needed to ensure appropriate access to digestive health care in Canada. Outcomes can be evaluated by the 'point-of-care', practice audit methodology used for the present study.

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Section: Discussionmentioning

confidence: 99%

Access to Specialist Gastroenterology Care in Canada: Comparison of Wait Times and Consensus Targets

Leddin

Armstrong²,

Barkun³

et al. 2008

Canadian Journal of Gastroenterology

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“…Over thelastseveraldecades,therapeutic advances in the treatment of pediatric Crohn disease (CD) have included the widespread use of immunomodulators such as 6-mercaptopurine, azathioprine, and methotrexate. [1][2][3] More recently, the anti-tumor necrosis factor a (anti-TNFa) biological agents (eg, infliximab and adalimumab) have been adopted as a treatment of moderate to severe pediatric CD. 4 Although several studies on adult patients who have CD have shown a comparative benefit of anti-TNFa versus placebo 5 and thiopurines, 6 these same studies have not been done in children because of practical (time and cost) and ethical (withholding an efficacious treatment) challenges.…”

mentioning

confidence: 99%

Effectiveness of Anti-TNFα for Crohn Disease: Research in a Pediatric Learning Health System

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Studies on adult patients who have Crohn disease have shown a comparative benefit of antiTNFa versus placebo and thiopurines. These same studies have not been done in children, because of time, cost, and ethical (withholding an efficacious treatment) challenges. WHAT THIS STUDY ADDS:Anti-TNFa therapy administered in routine practice to children with Crohn disease was more effective than usual care at achieving clinical and corticosteroid-free remission. Using data from the ImproveCareNow learning health system for observational research is feasible and produces valuable evidence. abstract OBJECTIVES: ImproveCareNow (ICN) is the largest pediatric learning health system in the nation and started as a quality improvement collaborative. To test the feasibility and validity of using ICN data for clinical research, we evaluated the effectiveness of anti-tumor necrosis factor-a (anti-TNFa) agents in the management of pediatric Crohn disease (CD).METHODS: Data were collected in 35 pediatric gastroenterology practices (April 2007 to March 2012 and analyzed as a sequence of nonrandomized trials. Patients who had moderate to severe CD were classified as initiators or non-initiators of anti-TNFa therapy. Among 4130 patients who had pediatric CD, 603 were new users and 1211 were receiving anti-TNFa therapy on entry into ICN.RESULTS: During a 26-week follow-up period, rate ratios obtained from Cox proportional hazards models, adjusting for patient and disease characteristics and concurrent medications, were 1.53 (95% confidence interval [CI], 1.20-1.96) for clinical remission and 1.74 (95% CI, 1.33-2.29) for corticosteroid-free remission. The rate ratio for corticosteroid-free remission was comparable to the estimate produced by the adult SONIC study, which was a randomized controlled trial on the efficacy of anti-TNFa therapy. The number needed to treat was 5.2 (95% CI, 3.4-11.1) for clinical remission and 5.0 (95% CI, 3.4-10.0) for corticosteroid-free remission. CONCLUSIONS:In routine pediatric gastroenterology practice settings, anti-TNFa therapy was effective at achieving clinical and corticosteroidfree remission for patients who had Crohn disease. Using data from the ICN learning health system for the purpose of observational research is feasible and produces valuable new knowledge. Over thelastseveraldecades,therapeutic advances in the treatment of pediatric Crohn disease (CD) have included the widespread use of immunomodulators such as 6-mercaptopurine, azathioprine, and methotrexate. [1][2][3] More recently, the anti-tumor necrosis factor a (anti-TNFa) biological agents (eg, infliximab and adalimumab) have been adopted as a treatment of moderate to severe pediatric CD. 4 Although several studies on adult patients who have CD have shown a comparative benefit of anti-TNFa versus placebo 5 and thiopurines, 6 these same studies have not been done in children because of practical (time and cost) and ethical (withholding an efficacious treatment) challenges.The cost of anti-TNFa is in the range...

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“…These drugs allow corticosteroid withdrawal and maintain clinical remission at the first 2 years of treatment in 44%-80% of pediatric patients [97][98][99]. The only pediatric CD randomized, placebo controlled trial reported by Markowitz et al [97] failed to demonstrate any benefit of 6-MP on growth parameters compared to placebo after 18 months of follow-up. This study is limited by small sample size and relatively high number of withdrawals from the placebo arm.…”

Section: Immunosuppressive Therapymentioning

confidence: 99%

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

Shamir¹

2014

J Clin Cell Immunol

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Growth retardation is a common complication of pediatric inflammatory bowel disease (IBD), which may have long term effects on final adult height and carries significant social and psychological implications. Etiology may be multifactorial including undernutrition, metabolic dysregulation, inflammatory impact on hormonal growth axis and the effect of drugs such as glucocorticoids. Control of disease activity and minimizing the need for corticosteroid therapy are necessary measures in order to facilitate normal growth. However, in many cases these strategies are not sufficient. Currently, there is inconsistent evidence regarding the efficacy of available therapeutic agents to induce long-term effect on growth. The new era of biologic therapies which carries a greater potential to achieve mucosal healing, holds promise for better growth even in children with severe growth impairment. It becomes apparent that prompt recognition of growth impairment combined with aggressive tailored therapeutic approach may offer the best chance for catch-up growth. This review will discuss the definition, prevalence and mechanism of growth retardation in children with IBD and highlight the specific benefits of current therapeutic strategies.

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A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn's disease

Cited by 700 publications

References 31 publications

Access to Specialist Gastroenterology Care in Canada: Comparison of Wait Times and Consensus Targets

Access to Specialist Gastroenterology Care in Canada: Comparison of Wait Times and Consensus Targets

Effectiveness of Anti-TNFα for Crohn Disease: Research in a Pediatric Learning Health System

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

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