Drug-induced Lung Disease Associated With Ustekinumab in a Pediatric Patient With Crohn Disease

Mitchel, Elana B.; Paul, Adam; El-Ali, Alexander; Cheng, Pi Chun; Albenberg, Lindsey

doi:10.1097/mpg.0000000000002783

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…[40] Also, another case described drug-induced lung disease after starting Ustekinumab; the child complained of shortness of breath, chest pain, and cough. [41] Adult clinical trials are expanding the therapeutic options for IBD patients, but the time lag between adult and pediatric drug approval results in significant off-label use due to a lack of knowledge about optimal pediatric dosing regimens. Clinical trials in bio-naive and bio-expert IBD children particularly those who are young and low-weight are needed.…”

Section: Discussionmentioning

confidence: 99%

Ustekinumab for steroid-refractory pancolitis in a biologically naive child: A case report and literature review

Alhalabi

2023

Medicine

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Ustekinumab is not recommended for the treatment of children with inflammatory bowel disease, but its off-label use is increasing despite a lack of pediatric pharmacokinetic data. The purpose of this review is to evaluate the therapeutic effects of Ustekinumab on children with inflammatory bowel disease and to recommend the best treatment regimen. Ustekinumab was the first biological treatment for a 10-year-old Syrian boy with steroid-refractory pancolitis who weighed 34 kg. A 260 mg/kg (~6 mg/kg) intravenous dose was followed by 90 mg of subcutaneous Ustekinumab at week 8 (induction). The patient was supposed to receive the first maintenance dose after twelve weeks, but after ten weeks, he developed acute severe ulcerative colitis which was managed according to treatment guidelines, except receiving 90 mg of subcutaneous Ustekinumab when he was discharged. The maintenance dose of 90 mg subcutaneous Ustekinumab was intensified to every 8 weeks. Throughout the treatment period, he achieved and maintained clinical remission. In pediatric inflammatory bowel disease, a dose of intravenous ~6 mg/kg of Ustekinumab is a common induction regimen, while children weighing < 40 kg may require a dose of 9 mg/kg. For maintenance, children may require 90 mg of subcutaneous Ustekinumab every 8 weeks. The outcome of this case report is interesting with improved clinical remission and highlighting the expansion of clinical trials on Ustekinumab for children.Abbreviations: anti-TNF = necrosis factor antagonists, IBD = inflammatory bowel disease, PUCAI = pediatric ulcerative colitis activity index, SC = subcutaneous, UC = ulcerative colitis.

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Section: Discussionmentioning

confidence: 99%

Ustekinumab for steroid-refractory pancolitis in a biologically naive child: A case report and literature review

Alhalabi

2023

Medicine

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“…Recently, a case of a child experiencing VED-associated pulmonary disease was published, probably based on an integrin shift leading to proliferation of CD29 + lymphocytes (β1-integrin), which amplifies lymphocyte homing to the lung [170]. Mitchel et al reported the case of a child with non-infectious bilateral pneumonia after the initiation of immunosuppressive therapy with UST [171]. To our knowledge, although reports of ADA-induced interstitial lung disease in adult IBD have been published, no pediatric cases have been mentioned to date [172].…”

Section: Medication-associated Lung Injurymentioning

confidence: 99%

Pathophysiological Concepts and Management of Pulmonary Manifestation of Pediatric Inflammatory Bowel Disease

Schmid

Chao

Däbritz

2022

IJMS

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Pulmonary manifestation (PM) of inflammatory bowel disease (IBD) in children is a rare condition. The exact pathogenesis is still unclear, but several explanatory concepts were postulated and several case reports in children were published. We performed a systematic Medline search between April 1976 and April 2022. Different pathophysiological concepts were identified, including the shared embryological origin, “miss-homing” of intestinal based neutrophils and T lymphocytes, inflammatory triggering via certain molecules (tripeptide proline-glycine-proline, interleukin 25), genetic factors and alterations in the microbiome. Most pediatric IBD patients with PM are asymptomatic, but can show alterations in pulmonary function tests and breathing tests. In children, the pulmonary parenchyma is more affected than the airways, leading histologically mainly to organizing pneumonia. Medication-associated lung injury has to be considered in pulmonary symptomatic pediatric IBD patients treated with certain agents (i.e., mesalamine, sulfasalazine or infliximab). Furthermore, the risk of pulmonary embolism is generally increased in pediatric IBD patients. The initial treatment of PM is based on corticosteroids, either inhaled for the larger airways or systemic for smaller airways and parenchymal disease. In summary, this review article summarizes the current knowledge about PM in pediatric IBD patients, focusing on pathophysiological and clinical aspects.

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Safety Summary of Pediatric Inflammatory Bowel Disease Therapies

Zhang

Rosh

2023

Gastroenterology Clinics of North America

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Drug-induced Lung Disease Associated With Ustekinumab in a Pediatric Patient With Crohn Disease

Cited by 3 publications

References 8 publications

Ustekinumab for steroid-refractory pancolitis in a biologically naive child: A case report and literature review

Ustekinumab for steroid-refractory pancolitis in a biologically naive child: A case report and literature review

Pathophysiological Concepts and Management of Pulmonary Manifestation of Pediatric Inflammatory Bowel Disease

Safety Summary of Pediatric Inflammatory Bowel Disease Therapies

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