Adalimumab for endoscopic and histopathological mucosal healing in paediatric patients with moderate to severe Crohn's disease.
BACKGROUND
Deep remission, defined as clinical remission with mucosal healing (MH), with anti-tumor necrosis factor (TNF)-α agents is a new target for therapy in Crohn's disease (CD). Provided that the efficacy of infliximab (IFX) for induction of MH in CD has been demonstrated, there are much less data for adalimumab (ADA), and none concerning MH on histopathological examination.


OBJECTIVE
To assess the impact of biological therapy with ADA on both endoscopic and histopathological MH in paediatric patients with CD.


METHODS
Twenty-three children (10 boys and 13 girls) aged 13.0 ±9.3 years with moderate to severely active CD diagnosed at the mean age of 5.5 ±0.83 years were included into the study. Seven (30.4%) patients had been previously treated with infliximab and switched to ADA due to intolerance or loss of response. Colonoscopy and gastroscopy with sample collection were performed in all patients before and after induction treatment with ADA. Clinical activity of the disease was assessed using the Paediatric Crohn's Disease Activity Index (PCDAI), and the endoscopic activity was scored using the Simple Endoscopic Score (SES-CD). Histological changes were evaluated by a self-adapted numerical scoring system.


RESULTS
Four (17.4%) patients reached clinical remission (PCDAI ≤ 10). When comparing data at baseline and at a week after ADA treatment, a significant decrease was observed in median PCDAI and in SES-CD score between the initial and control colonoscopies. We reported a decrease in histological scale, which was not statistically significant. A correlation was found between PCDAI and SES-CD score.


CONCLUSIONS
Biological therapy with ADA has a positive impact on endoscopic mucosal healing in paediatric patients with CD, which is not associated with histological evidence of suppression of inflammation. Endoscopic MH correlates better than microscopic one with clinical remission.
Department of Paediatrics, Nutrition and Metabolic Disorders, Children's Memorial Health Institute, Warsaw, Poland.
Edyta
E
Szymanska
Department of Gastroenterology, Hepatology, and Feeding Disorders, Children's Memorial Health Institute, Warsaw, Poland.
Maciej
M
Dadalski
Department of Pathology, Children's Memorial Health Institute, Warsaw, Poland.
Wieslawa
W
Grajkowska
Department of Pathology, Children's Memorial Health Institute, Warsaw, Poland.
Sylwia
S
Szymanska
Department of Pathology, Children's Memorial Health Institute, Warsaw, Poland.
Maciej
M
Pronicki
Department of Gastroenterology, Hepatology, and Feeding Disorders, Children's Memorial Health Institute, Warsaw, Poland.
Jaroslaw
J
Kierkus
Crohn’s disease; adalimumab; deep remission; mucosal healing