The pharmacotherapeutic management of pediatric Crohn’s disease

Zimmerman, Lori A.; Bousvaros, Athos

doi:10.1080/14656566.2019.1659778

Cited by 14 publications

(10 citation statements)

References 50 publications

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“…If MTX is ineffective or intolerant, then 6-MP can be used to maintain remission for those reach remission; however, haematological toxicity and pancreatitis are major problems at start of therapy [11]. IFX, an antitumor necrosis factor alpha (TNF-α) agent, is employed for both induction and maintenance of remission therapy among the patients with moderate to severe CD [12]. It was reported that IFX was superior to conventional treatment in achieving short-term clinical and endoscopic remission [13].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Pediatric Patients with Crohn’s Disease Received Infliximab or Exclusive Enteral Nutrition during Induction Remission

Lou

Yang

et al. 2022

Gastroenterology Research and Practice

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Background. Both exclusive enteral nutrition (EEN) and infliximab (IFX) are recommended as induction therapy for pediatric Crohn’s disease (CD). Our aim was to compare long-term disease outcomes of patients initially received with either IFX or EEN. Methods. Medical records of newly diagnosed, therapy naïve pediatric patients with CD received with IFX or EEN as induction therapy were retrospectively enrolled. Pediatric Crohn’s disease activity index (PCDAI), Crohn’s disease endoscopic index of severity (CDEIS), and other clinical data were compared pre- and postinduction therapy in two groups. The sustained remission rates and time coupled with body mass index (BMI) and height for age (HFA) changes were evaluated during more than 2-year long-term follow-up. Results. We collected data from 58 children with CD used IFX (23) or EEN (35) as induction remission therapy from January 2015 through June 2021 in our single-center. The median follow-up after starting IFX or EEN was 12.2 months (6.5–18.0months) and 18.9 months (7.1–30.7months), respectively. The proportion clinical and endoscopic remission in EEN (88.57% and 68.75%) was similar with that of IFX (73.91% and 80.77%) after induction therapy. No significant differences were also observed in BMI and HFA recovery between two groups. Among those who achieved clinical or endoscopic remission or endoscopic response, the sustained remission rates and time did not reveal any significant differences for those 10 patients who used 6-mercaptopurine/methotrexate (6-MP/MTX) or 14 patients who used IFX as maintenance treatment during longitudinal follow-up. Conclusions. Our study suggested that EEN treatment is similar with IFX therapy in short-term outcomes, and EEN+6-MP/MTX treatment is comparable with IFX+IFX therapy in long-term outcomes.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Pediatric Patients with Crohn’s Disease Received Infliximab or Exclusive Enteral Nutrition during Induction Remission

Lou

Yang

et al. 2022

Gastroenterology Research and Practice

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“…Depending on the study, glucocorticoids users represent between 0.5% and 20% of the population (1)(2)(3)(4), with approximately 1% with chronic use (1,3). In pediatrics, glucocorticoids are commonly used in asthma (5), eczema (6), inflammatory diseases such as Crohn disease (7) or arthritis (8) and in acute leukemia (9) or Graft vs. Host disease (GvHD) (10) treatment.…”

Section: Introductionmentioning

confidence: 99%

Glucocorticoid induced adrenal insufficiency in children: Morning cortisol values to avoid LDSST

et al. 2022

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ObjectivesGlucocorticoid-induced adrenal insufficiency (GI-AI) is a common side effect of glucocorticoid therapy. However, its diagnosis currently relies on the realization of a Low Dose Short Synacthen Test (LD-SST) that requires an outpatient hospital and several blood samples. Our goal was to evaluate whether morning cortisol values could predict the response to LD-SST, in children, to avoid useless dynamic tests and facilitate diagnosis of glucocorticoid induced adrenal insufficiency.Study DesignWe recorded data of 91 pediatric patients who underwent a LD-SST in our center between 2016 and 2020 in a retrospective observational study. We selected LD-SST realized following administration of supra-physiologic doses of glucocorticoids during more than 3 weeks and performed at least four weeks after treatment was stopped. Adrenal deficiency was defined as a plasma cortisol concentration inferior to 500 nmol/l at LD-SST.ResultsGlucocorticoid-induced adrenal insufficiency was diagnosed in 60% of our cohort. Morning cortisol values were predictive of the response to the LD-SST (AUC ROC 0.78). A plasma cortisol concentration of less than 144 nmol/l predicted glucocorticoid induced adrenal insufficiency with a specificity of 94% and a value over 317 nmol/l predicted recovery of the HPA axis with a sensitivity of 95%. We did not find any other predictive factor for glucocorticoid-induced adrenal insufficiency.ConclusionsMorning cortisol values can safely assess recovery of the HPA axis in children treated chronically with glucocorticoids. Using these thresholds, more than 50% of LD-SST could be avoided in children.

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“…Growth retardation in children: Pediatric CD often presents as a triad of abdominal pain, diarrhea, and weight loss, characterized by growth retardation[ 49 , 50 ]. Therefore, the pediatric treatment of CD induces and maintains clinical remission of the disease and optimizes nutrition and growth as soon as possible[ 51 ]. Surgery should be performed before puberty for prepubertal or early pubertal patients with severe malnutrition resulting in growth arrest[ 52 ].…”

Section: Surgical Indications For CDmentioning

confidence: 99%

Timing of individualized surgical intervention in Crohn’s disease

Xia¹,

Gao²,

Wu³

et al. 2022

World J Gastrointest Surg

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Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract with an increasing incidence worldwide. Comprehensive therapy for CD focuses on symptom control and healing the intestinal mucosa to improve the quality of life and prevent complications. Surgical intervention plays a vital role in comprehensive therapy. However, deciding the optimal timing for surgical intervention has long been a focus of controversy. This review provides insights into the timing of surgery for CD and guides clinicians in daily treatment.

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The pharmacotherapeutic management of pediatric Crohn’s disease

Cited by 14 publications

References 50 publications

Outcomes of Pediatric Patients with Crohn’s Disease Received Infliximab or Exclusive Enteral Nutrition during Induction Remission

Outcomes of Pediatric Patients with Crohn’s Disease Received Infliximab or Exclusive Enteral Nutrition during Induction Remission

Glucocorticoid induced adrenal insufficiency in children: Morning cortisol values to avoid LDSST

Timing of individualized surgical intervention in Crohn’s disease

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