A real-world study focused on the effectiveness and safety of adalimumab as first-line anti-TNF treatment for paediatric Crohn's disease

Navas-López, Víctor Manuel; Pujol-Muncunill, Gemma; Llerena, Enrique; Rubio, María Navalón; Gil-Ortega, David; Varea-Calderón, Vicente; Salinas, C. Sierra; Martín-de-Carpi, Javier

doi:10.1016/j.anpede.2017.03.001

Cited by 3 publications

(1 citation statement)

References 38 publications

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“…Rosh et al (22) found similar results with 42% remission at 1 year in 115 children, but again comparison with our cohort is difficult because 95% of the patients in the RESEAT registry had previously received infliximab, and a quarter of the cohort was steroid-dependent at 6 months. A Spanish multicenter retrospective study of 62 pediatric patients treated with ADA as first-line anti-TNFα therapy found a 95% remission rate at 1 year, but with a median wPCDAI of 35 at diagnosis predicting a less severe disease course compared to our study (23).…”

Section: Discussioncontrasting

confidence: 67%

Adalimumab Therapy in Pediatric Crohn Disease: A 2-Year Follow-Up Comparing “Top-Down” and “Step-Up” Strategies

Payen

Neuraz

Zenzeri

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: European Crohn’s Colitis Organization (ECCO) and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines recommend the early use of anti-tumor necrosis factor (TNF) biologicals in pediatric Crohn disease (CD) patients with positive predictors for poor outcome. The objective of the present study was to compare early “Top-Down” use of adalimumab (ADA) immunomodulator/biologics-naive patients to conventional “Step-Up” management. Methods: One hundred and twenty consecutive patients with a confirmed diagnosis of CD and treated with ADA between 2008 and 2019 were included and allocated to the ADA-Top Down (n = 59) or ADA-Step Up group (n = 61). The primary endpoint was prolonged steroid-/enteral nutrition-free clinical remission at 24 months, defined by a weighted Pediatric Crohn’s Disease Activity Index (wPCDAI) < 12.5. Clinical and biological data were collected at 12 and 24 months. Results: At start of ADA, disease activity was comparable between the ADA-Top Down group and the ADA-Step Up group (wPCDAI = 31 ± 16 vs 31.3 ± 15.2, respectively, P = 0.84). At 24 months, the remission rate was significantly higher in the ADA-Top Down group (73% vs 51%, P < 0.01). After propensity score, the Top-Down strategy is still more effective than the Step-Up strategy in maintaining remission at 24 months [hazard ratio (HR) = 0.36, 95% CI (0.15–0.87), P = 0.02]. Patients in the ADA-Top Down group were mainly on monotherapy compared to patients in the ADA-Step Up group (53/55 vs 28/55 respectively, P < 0.001). Serum levels of ADA were higher in the ADA-Top Down group than in the ADA-Step Up group (12.8 ± 4.3 vs 10.4 ± 3.9 µg/mL, respectively, P < 0.01). There were no serious adverse events. Conclusions: Early use of ADA appears to be more effective in maintaining relapse-free remission at 2 years, while using it as monotherapy. These findings further favor the recommendation of early anti-TNF use in high-risk CD patients.

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Section: Discussioncontrasting

confidence: 67%

Adalimumab Therapy in Pediatric Crohn Disease: A 2-Year Follow-Up Comparing “Top-Down” and “Step-Up” Strategies

Payen

Neuraz

Zenzeri

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Anthocyanin composition of fruit extracts from Lycium ruthenicum and their protective effect for gouty arthritis

Zhang

Chen

Zhou

et al. 2019

Industrial Crops and Products

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Adalimumab in Pediatric Inflammatory Bowel Disease

Choi

Kang

2022

Front. Pediatr.

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The introduction of biological agents with strong anti-inflammatory action, such as antitumor necrosis factor (TNF) agents, has changed inflammatory bowel disease (IBD) treatment strategy and goals, and has contributed significantly to improve the long-term prognosis of patients. Moreover, several biological agents are being used or researched in pediatric populations. However, only two biological agents, infliximab (IFX) and adalimumab (ADL), are currently approved for children and adolescents. In pediatric IBD, there are limitations and burdens associated with facilitating mucosal healing (MH) when utilizing these two biological agents. ADL is effective in both naïve patients and those with previous experience with biologics. Beyond clinical remission, this drug is also effective for MH and histological remission. The use of therapeutic drug monitoring to further enhance the effectiveness of ADL treatment can be expected to reduce treatment failure of ADL and pave the way for appropriate treatment in the treat-to-target era. This review paper focuses on ADL, examine studies conducted in children, and determine the role this agent plays against pediatric inflammatory bowel disease.

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A real-world study focused on the effectiveness and safety of adalimumab as first-line anti-TNF treatment for paediatric Crohn's disease

Cited by 3 publications

References 38 publications

Adalimumab Therapy in Pediatric Crohn Disease: A 2-Year Follow-Up Comparing “Top-Down” and “Step-Up” Strategies

Adalimumab Therapy in Pediatric Crohn Disease: A 2-Year Follow-Up Comparing “Top-Down” and “Step-Up” Strategies

Anthocyanin composition of fruit extracts from Lycium ruthenicum and their protective effect for gouty arthritis

Adalimumab in Pediatric Inflammatory Bowel Disease

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