Mucosal healing in pediatric Crohn's disease after anti-TNF therapy: a long-term experience at a single center.
OBJECTIVE
The anti-tumor necrosis factor (TNF) agents infliximab (IFX) and adalimumab (ADA) have been recently introduced to treat severe inflammatory bowel disease (IBD) that is unresponsive to other drugs. Several studies have confirmed the safety and efficacy of these agents for adult IBD patients, whereas there is less data on pediatric IBD. Mucosal healing, associated with fewer complications and surgeries, is considered the goal of treatment by some authors. The objective of this study was to evaluate the safety and efficacy (in terms of endoscopic, clinical, and laboratoristic response) of IFX and ADA in a cohort of pediatric patients with Crohn's disease (CD).


METHODS
We conducted a retrospective analysis of prospectively collected data; we studied 33 patients (20 male, 13 female) with a diagnosis of CD established before 18 years of age: 29/33 were treated with IFX and 19/33 received ADA (four of them were naive to IFX). We evaluated clinical, endoscopic, and laboratoristic response to IFX and ADA for each patient and recorded the adverse effects of these drugs.


RESULTS
With regard to IFX treatment, 22.2% of patients achieved mucosal healing and 44.4% showed an endoscopic response. With regard to ADA therapy, 25% of patients achieved mucosal healing and 50% showed an endoscopic response. Overall clinical response rates for IFX and ADA were 84 and 92.3%, respectively. Both drugs were well tolerated.


CONCLUSIONS
To our knowledge, this is the first study reporting mucosal healing after ADA therapy in pediatric CD. We found significant mucosal healing and response rates in our group of patients. Compared with other pediatric studies, we reported similar clinical response rates and longer follow-up of patients.
aInflammatory Bowel Disease Unit, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna bMaternal and Child Department, Ospedali Riuniti di Ancona, Ancona, Italy.
Stefano
S
Nobile
Paolo
P
Gionchetti
Fernando
F
Rizzello
Carlo
C
Calabrese
Massimo
M
Campieri
D000068879:Adalimumab; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D007558:Italy; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014945:Wound Healing / Q000187:drug effects*
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab