Evaluation of the infliximab therapy of severe form of pediatric Crohn’s disease in Poland: Retrospective, multicenter studies

Iwańczak, Barbara; Kierkuś, Jarosław; Ryżko, Józef; Szczepanik, Mariusz; Więcek, Sabina; Czaja‐Bulsa, Grażyna; Kacperska, Magdalena Justyna; Korczowski, Bartosz; Maślana, Jolanta; Iwańczak, F

doi:10.17219/acem/42197

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…Stern et al showed that, in pediatric patients with TA, infliximab was as effective as cyclophosphamide with fewer side effects and thus is a viable alternative to treatment of pediatric TA [27]. Iwańczak et al has shown that children with moderate to severe ulcerative colitis have achieved remission with infliximab, and it was effective in preventing early colectomy [28]. Eleftheriou et al completed a retrospective descriptive case series of four children with CRMO or synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome treated with TNF alpha blockade and found that disease activity was improved for 3 of 4 children at 12 months after starting biologic therapy and the fourth discontinued therapy due to a suspected fungal skin infection [29].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Takayasu’s Arteritis and Ulcerative Colitis in a Pediatric Patient with Chronic Recurrent Multifocal Osteomyelitis Successfully Treated with Infliximab: Diagnostic Clues in Disease Associations and Immune Dysregulation

Guerra

Hashmi²,

Kramer

et al. 2019

Case Reports in Rheumatology

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Background. Takayasu’s arteritis with comorbid chronic recurrent multifocal osteomyelitis and ulcerative colitis is rare in the pediatric population. Treatment with anti-TNF alpha agents such as infliximab has been a successful treatment strategy in adults and can be used effectively in the pediatric population. Case Presentation. We present the case of a 15-year-old Caucasian girl with a history of chronic recurrent multifocal osteomyelitis and ulcerative colitis presenting with hypertensive emergency secondary to Takayasu’s arteritis with middle aortic syndrome. She was treated with corticosteroids and methotrexate and ultimately required infliximab infusions of 15 mg/kg every 4 weeks to successfully control her symptoms and normalize her inflammatory markers. Conclusions. In this case, we discuss the use of infliximab in an adolescent patient with chronic recurrent multifocal osteomyelitis, ulcerative colitis, and Takayasu’s arteritis. The significance of this case is determined by the unique occurrence of all three conditions in a pediatric patient, the important consideration of vasculitis in the differential of a pediatric patient presenting with hypertensive emergency, the need for vigilance for detecting diagnostic clues, signs, and symptoms, knowledge of disease associations when evaluating a patient with a predisposition for autoinflammatory conditions, and the use of increasing doses of infliximab to control symptoms.

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Section: Discussionmentioning

confidence: 99%

A Case Report of Takayasu’s Arteritis and Ulcerative Colitis in a Pediatric Patient with Chronic Recurrent Multifocal Osteomyelitis Successfully Treated with Infliximab: Diagnostic Clues in Disease Associations and Immune Dysregulation

Guerra

Hashmi²,

Kramer

et al. 2019

Case Reports in Rheumatology

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“…A 2011 systematic review showed a 1-year response rate of 64% ( 12 ). Other studies have demonstrated long-term response rates from 57 to 61% ( 16 , 23 ) in paediatric UC. In contrast, data from this study also suggest a less favourable response to steroids in Irish children with ASC.…”

Section: Discussionmentioning

confidence: 93%

Outcomes of a National Cohort of Children with Acute Severe Ulcerative Colitis

et al. 2018

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AimAll Irish children with ulcerative colitis (UC) attend the National Centre for Paediatric Gastroenterology at Our Lady’s Children’s Hospital, Crumlin. The aim of this study was to determine the outcomes of children with acute severe ulcerative colitis (ASC) and the impact of infliximab on these outcomes following its introduction for this indication in 2011.MethodsA retrospective chart review of all patients admitted with ASC between January 1, 2009 and December 31, 2015 was undertaken. Patients were identified from the departmental database cross-referenced with the hospital inpatient enquiry system. Inpatients with a paediatric ulcerative colitis activity index (PUCAI) of ≥65 were included. Data collected included baseline demographic and laboratory data, concomitant treatments, PUCAI scores on days 3 and 5, second-line treatments, surgery, and discharge outcomes. Infliximab dose, frequency, and available therapeutic drug monitoring results were recorded, along with clinical response outcomes (remission, primary, and secondary loss of response). The cohort was sub-analysed to determine if there was any era effect pre- and post-introduction of infliximab (2009–2010 and 2011–2015, respectively).ResultsFifty-five patients (M:F = 1.4:1) were treated for acute severe colitis over the study period (8 in the pre-infliximab and 47 in the post-infliximab era) and 46/55 (86%) had steroid-refractory disease. Of these, 7/8 (88%) required colectomy in the pre-infliximab era, compared with 15/47 (36%) in the post-infliximab era. The remission rate with second-line infliximab was 61% at maximal follow-up. There were no identifiable factors that predicted likely success or failure of infliximab, including gender, CRP, day-3 and day-5 PUCAI scores. Of the 33 patients treated with infliximab, dose increase was required in 23/33 (70%); 21/33 (64%) received an accelerated dose schedule, and 9/33 (27%) eventually needed colectomy. Primary and secondary loss of response to infliximab was seen in one and nine patients, respectively.ConclusionThis is the first population-based study of the outcomes of severe UC in Irish children, and suggests a higher burden of steroid-refractory disease compared with previous international studies. While infliximab treatment has led to reduction in colectomy rates, a significant proportion of patients lose therapeutic effect.

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“…Previous studies have shown that TNF-α levels are significantly increased in IBD patients (Murch et al, 1993; Billmeier et al, 2016). The treatment of IBD patients with TNF-α monoclonal antibody (such as infliximab and golomumab) could effectively alleviate the disease (Rutgeerts et al, 2005; Sandborn et al, 2014; Iwanczak et al, 2017). In addition, IL-10 is an important anti-inflammatory cytokine in the body.…”

Section: Discussionmentioning

confidence: 99%

Huang-Lian-Jie-Du Decoction Ameliorates Acute Ulcerative Colitis in Mice via Regulating NF-κB and Nrf2 Signaling Pathways and Enhancing Intestinal Barrier Function

et al. 2019

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Evidence shows that intestinal inflammation, oxidative stress, and injury of mucosal barrier are closely related to the pathogenesis of ulcerative colitis (UC). Huang-lian-Jie-du Decoction (HLJDD) is a well-known prescription of traditional Chinese medicine with anti-inflammatory and antioxidative activities, which may be used to treat UC. However, its therapeutic effect and mechanism are still unclear. In this study, the UC model of BABL/c mice were established by DSS [3.5% (w/v)], and HLJDD was given orally for treatment at the same time. During the experiment, the clinical symptoms of mice were scored by disease activity index (DAI). Besides, the effects of HLJDD on immune function, oxidative stress, colon NF-κB and Nrf2 signaling pathway, and intestinal mucosal barrier function in UC mice were also investigated. The results showed that HLJDD could alleviate body weight loss and DAI score of UC mice, inhibit colonic shortening and relieve colonic pathological damage, and reduce plasma and colon MPO levels. In addition, HLJDD treatment significantly up-regulated plasma IL-10, down-regulated TNF-α and IL-1β levels, and inhibited the expression of NF-κB p65, p-IκKα/β, and p-IκBα proteins in the colon. Moreover, NO and MDA levels in colon tissues were significantly reduced after HLJDD treatment, while GSH, SOD levels and Nrf2, Keap1 protein expression levels were remarkably elevated. Additionally, HLJDD also protected intestinal mucosa by increasing the secretion of mucin and the expression of ZO-1 and occludin in colonic mucosa. These results indicate that HLJDD could effectively alleviate DSS-induced mice UC by suppressing NF-κB signaling pathway, activating Nrf2 signaling pathway, and enhancing intestinal barrier function.

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Evaluation of the infliximab therapy of severe form of pediatric Crohn’s disease in Poland: Retrospective, multicenter studies

Cited by 7 publications

References 11 publications

A Case Report of Takayasu’s Arteritis and Ulcerative Colitis in a Pediatric Patient with Chronic Recurrent Multifocal Osteomyelitis Successfully Treated with Infliximab: Diagnostic Clues in Disease Associations and Immune Dysregulation

A Case Report of Takayasu’s Arteritis and Ulcerative Colitis in a Pediatric Patient with Chronic Recurrent Multifocal Osteomyelitis Successfully Treated with Infliximab: Diagnostic Clues in Disease Associations and Immune Dysregulation

Outcomes of a National Cohort of Children with Acute Severe Ulcerative Colitis

Huang-Lian-Jie-Du Decoction Ameliorates Acute Ulcerative Colitis in Mice via Regulating NF-κB and Nrf2 Signaling Pathways and Enhancing Intestinal Barrier Function

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