Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn's Disease

Mack, David; Benchimol, Eric I; Critch, Jeff; deBruyn, Jennifer; Tse, Frances; Martin, Paul; Church, Peter; Deslandres, Colette; El‐Matary, Wael; Huynh, Hien Q.; Jantchou, P; Lawrence, Sally; Otley, Anthony; Sherlock, Mary; Walters, Thomas D.; Kappelman, Michael D.; Sadowski, Dan; Marshall, John K.; Griffiths, Anne M.

doi:10.1053/j.gastro.2019.03.022

Cited by 52 publications

(45 citation statements)

References 177 publications

(296 reference statements)

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“…ADL was discontinued upon occurrence of high antibodies to ADL (≥8 μg/mL) or adverse events, or no further intensification option available (capped at 80 mg weekly). Patients who were off ADL treatment might receive further gastrointestinal work‐up for evaluation of surgical resection or switching to infliximab treatment 17,18 . If relapse occurred on infliximab therapy, the patient might receive surgical resection or switching to ustekinumab.…”

Section: Methodsmentioning

confidence: 99%

“…If relapse occurred on infliximab therapy, the patient might receive surgical resection or switching to ustekinumab. If relapse occurred on ustekinumab therapy, the patient would receive surgical 17–19 …”

Section: Methodsmentioning

confidence: 99%

“… ‡ Drug cost of ustekinumab was approximated with induction dose (90 mg weekly for 3 weeks) and maintenance dose (90 mg every 8 weeks) 17,18 …”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Proactive therapeutic drug monitoring of adalimumab for pediatric Crohn's disease patients: A cost‐effectiveness analysis

Yao

Jiang

You

2021

J of Gastro and Hepatol

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Background and Aim Recent clinical findings showed proactive therapeutic drug monitoring (TDM) of adalimumab (ADL) to improve sustained remission rate in pediatric patients with Crohn's disease (CD). The present study aimed to evaluate the potential cost‐effectiveness of proactive versus reactive TDM of ADL in pediatric patients with CD from the perspective of the US health‐care provider. Methods A Markov model was constructed to estimate outcomes of proactive versus reactive TDM of ADL in a hypothetical cohort of pediatric CD patients who were in remission on ADL maintenance treatment. Model inputs were derived from published literature and public data. Model outcomes included CD‐related direct medical cost and quality‐adjusted life‐years (QALYs). Sensitivity analyses were performed to examine the robustness of base‐case results. Results When compared with the reactive TDM group, the proactive TDM group saved 0.1960 QALYs at lower cost by USD2021 over a 3‐year time frame in base‐case analysis. One‐way sensitivity analysis showed the ADL drug cost to be the most influential factor. Probabilistic sensitivity analysis of 10 000 Monte‐Carlo simulations found the proactive TDM group to gain 0.1958 QALYs (95% confidence interval [CI] 0.1950–0.1966; P < 0.001) and save USD2037 (95%CI USD1943–2131; P < 0.001). Conclusions Proactive TDM for ADL seems to gain higher QALYs at lower cost in pediatric CD patients.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Proactive therapeutic drug monitoring of adalimumab for pediatric Crohn's disease patients: A cost‐effectiveness analysis

Yao

Jiang

You

2021

J of Gastro and Hepatol

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“…Furthermore, it promotes mucosal healing without serious side effects [25,26]. This approach is used as a first line treatment in pediatric Crohn's disease in Asia, Europe, and Canada [27][28][29], but there are great variations in regional use [30]. The composition of the formula does not appear to matter [25].…”

Section: Dietary Therapymentioning

confidence: 99%

Making Decisions about Dietary Therapy in Inflammatory Bowel Disease

Solomon

Park

Picoraro

2020

Gastrointestinal Disorders

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Treatment for inflammatory bowel disease (IBD) deserves an informed shared decision-making process between patient and doctor. IBD spans a spectrum of phenotypes that impact each patient uniquely. While treatment has primarily consisted of medical or surgical therapy, dietary approaches have become increasingly relevant. A majority of patients with IBD use some form of dietary modification, and it is common for patients to do this without their physicians’ knowledge. Lack of medical supervision can lead to nutritional deficiencies and a worsening disease state. Some patients work with their medical team to pursue a well-defined exclusion diet as a primary therapy, such as the specific carbohydrate diet, exclusive enteral nutrition, or the Crohn’s disease exclusion diet. The motivations to use dietary therapy for IBD remain unclear and the effectiveness has not been definitively established for many approaches. It is necessary for medical providers to be knowledgeable and to foster open communication with their patients in order to ensure the highest likelihood of remission. This review provides an overview of dietary treatment options, the current knowledge about patient motivations for pursuing dietary therapy, and the roles of patient empowerment and patient activation. We outline areas of improvement for the decision-making process.

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“…However, the main line of treatment to induce remission in children with mild to moderate CD remains exclusive enteral nutrition (EEN). Corticosteroids and 5‐aminosalicylates are the main medications for induction of remission in children with ulcerative colitis (UC) 6 …”

Section: Introductionmentioning

confidence: 99%

Trends in paediatric inflammatory bowel disease‐attributable direct costs: a population‐based analysis

El-Matary

Nugent

Witt

et al. 2021

Aliment Pharmacol Ther

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SummaryBackgroundIn addition to its morbidities, inflammatory bowel disease (IBD) has a major financial burden on patients and healthcare systems. However, there is a paucity of evidence on IBD‐attributable costs in children.AimsTo determine the trends of IBD‐attributable direct costs over time using a population‐based analysis.MethodsData were extracted from Manitoba Health Provider Claims and other population registry datasets from 1995 to 2017. Children with IBD were matched by age, sex and location with children without IBD. IBD‐attributable direct costs were calculated using utilization counts from the administrative data and cost estimates from different sources. Inpatient hospitalisation and outpatient procedure costs were estimated using the resource intensity weight (RIW) that is attached to each record in the data. Costs were expressed in Canadian dollars.ResultsWe included 733 (428 with Crohn's disease) prevalent cases who were diagnosed with IBD before the age of 18 years and were followed for 2450 person‐years. A matched control group of 6763 persons who were followed for 21 558 person‐years was included. The median annual costs of physician services billed per patient increased from $381 (IQR 215‐1064) in 1995 to $936 (IQR 579‐1932) in 2017 (P < 0.001). The annual medication costs per patient increased from a median of $270 in 1995 to $7944 in 2017 (P < 0.0001). The median annual direct cost per patient was $1810 in 2004 as compared to $14 791 (P < 0.0001) in 2017.ConclusionsOver two decades, there was a significant increase in the paediatric IBD‐attributable direct costs mainly driven by medication costs.

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Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn's Disease

Cited by 52 publications

References 177 publications

Proactive therapeutic drug monitoring of adalimumab for pediatric Crohn's disease patients: A cost‐effectiveness analysis

Proactive therapeutic drug monitoring of adalimumab for pediatric Crohn's disease patients: A cost‐effectiveness analysis

Making Decisions about Dietary Therapy in Inflammatory Bowel Disease

Trends in paediatric inflammatory bowel disease‐attributable direct costs: a population‐based analysis

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