Biological Therapy for Inflammatory Bowel Disease in Children

Na, So Young; Shim, Jung Ok

doi:10.5223/pghn.2012.15.1.13

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…To our knowledge, this is the first study reported in Korea comparing the efficacies of 'top-down' infliximab treatment and 'step-up' treatment for pediatric CD over a 3-year period [10,27,28]. Although, relapse rate at 1 and 3 years was not significantly different, the relapse rate of the 'top-down' group was lower than that of the 'step-up' group.…”

Section: Discussionmentioning

confidence: 84%

Efficacy of Early Infliximab Treatment for Pediatric Crohn's Disease: A Three-year Follow-up

Lee

Baek

Kim

et al. 2012

Pediatr Gastroenterol Hepatol Nutr

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PurposeTo investigate the efficacy of early infliximab use and to follow the progress of pediatric cases of Crohn's disease for 3 years.MethodsWe reviewed the medical records of 28 pediatric patients who had been treated with infliximab for Crohn's disease. Eighteen patients (the 'top-down' group) received infliximab and azathioprine for induction and maintenance therapy for the first year, and then were treated with azathioprine for 2 additional years. Ten patients who were refractory to conventional therapy were categorized in the 'step-up' group. All patients were followed for at least 36 months. Treatment efficacy was assessed by the relapse rate using the pediatric Crohn's disease activity index (PCDAI) score in each group at 12, 24, and 36 months. Blood samples were available from 10 patients, and were used to assess antibody to infliximab (ATI).ResultsThe relapse rate in 'top-down' group was lower than that in 'step-up' group at 1, 2, and 3 years. But, just the relapse rate at the 2 years was significantly different. At 3 years, the relapse rate according to different characteristic variables (sex, age at diagnosis, involvement, PCDAI at diagnosis) was not significantly different. Only one patient treated with infliximab had an adverse event, consisting of dyspnea and tachycardia. ATI was not detected in the blood samples from 10 patients.ConclusionEarly induction with infliximab at diagnosis ('top-down' therapy) is effective for reducing the relapse rate compared to conventional therapies in pediatric Crohn's disease possibly for up to 3 years.

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Section: Discussionmentioning

confidence: 84%

Efficacy of Early Infliximab Treatment for Pediatric Crohn's Disease: A Three-year Follow-up

Lee

Baek

Kim

et al. 2012

Pediatr Gastroenterol Hepatol Nutr

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“…The paradigm of medical treatment for pediatric CD has changed with the emergence of effective biologic agents including infliximab and adalimumab [4]. Decreased surgery rate has been associated with successful use of immunomodulator or biologic agent [56].…”

Section: Introductionmentioning

confidence: 99%

Surgery in Pediatric Crohn's Disease: Indications, Timing and Post-Operative Management

Kim

2017

Pediatr Gastroenterol Hepatol Nutr

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Pediatric onset Crohn's disease (CD) tends to have complicated behavior (stricture or penetration) than elderly onset CD at diagnosis. Considering the longer duration of the disease in pediatric patients, the accumulative chance of surgical treatment is higher than in adult onset CD patients. Possible operative indications include perianal CD, intestinal stricture or obstruction, abdominal abscess or fistula, intestinal hemorrhage, neoplastic changes and medically untreatable inflammation. Growth retardation is an operative indication only for pediatric patients. Surgery can affect a patient's clinical course, especially for pediatric CD patient who are growing physically and mentally, so the decision should be made by careful consideration of several factors. The complex and diverse clinical conditions hinder development of a systemized treatment algorithm. Therefore, timing of surgery in pediatric CD patients should be determined with individualized approach by an experienced and well organized multidisciplinary inflammatory bowel disease team. Best long-term outcomes will require proactive post-operative monitoring and therapeutic modifications according to the conditions.

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Biological Therapy for Inflammatory Bowel Disease in Children

Cited by 2 publications

References 21 publications

Efficacy of Early Infliximab Treatment for Pediatric Crohn's Disease: A Three-year Follow-up

Efficacy of Early Infliximab Treatment for Pediatric Crohn's Disease: A Three-year Follow-up

Surgery in Pediatric Crohn's Disease: Indications, Timing and Post-Operative Management

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