Adalimumab in pediatric ulcerative colitis
Journal Title: Postępy Nauk Medycznych - Year 2014, Vol 27, Issue 3
Abstract
Introduction. Adalimumab (ADA) has been shown to be effective in adult patients with moderately to severely active ulcerative colitis. Unfortunately, data about its role in pediatric patients are sparse.Aim. The aim of our study was to summarize the experience with adalimumab (ADA) used in therapy of pediatric patients with ulcerative colitis (UC) in our center.Material and methods. We retrospectively analyzed data of six children with active UC who have been treated with ADA in our hospital. Data about treatment history, concomitant therapy, and biochemical parameters were collected. We evaluated short term response to ADA as well as long term outcomes. PUCAI index was used to assess clinical condition of the subjects. Endoscopic features were classified according to Baron scale.Results. The mean age at diagnosis was 11.83 ± 2.78 years. The mean age at the time of first ADA injection was 14 ± 2.22 years. Mean duration of disease before ADA therapy was 23.8 ± 20.8 months. 5 patients were previously treated with infliximab. Indications for ADA were: hypersensitivity reaction to IFX (2 pts.), infliximab refractory UC (3 pts.), steroid dependency (1 pt.). One child didn’t response to ADA and had colectomy. At week 8, 2 of 6 patients had a clinical response. Mean PUCAI score at baseline was 32.5 ± 24.23, at week 8 was 19 ± 19.49. Five patients competed the induction phase and were entered into maintenance phase of the ADA therapy. One child has been excluded from long-term analysis. He received five injections of ADA and has been transferred to the center for adults. 4 patients after 6 months of ADA therapy maintained clinical remission (PUCAI < 10), in 2 cases remission was endoscopically assessed (grade O in Baron scale). After 12 months 3 patients were in clinical remission, in 2 cases colonoscopy has been performed (Baron scale 0 or 1). PUCAI index after 6 and 12 months were retrospectively 2.5 ± 2.88; 7.5 ± 11.9.Conclusions. Adalimumab is effective and safe treatment in pediatric ulcerative colitis intolerant to or with loss of effect to infliximab therapy. Should be considered as the rescue treatment before colectomy in this age group.
Authors and Affiliations
Anna Wiernicka, Maciej Dądalski, Monika Szychta, Grzegorz Oracz, Jarosław Kierkuś
Keywords
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