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Biological agents in paediatric inflammatory bowel disease: a clinical observation study from Greece
G Chouliaras1, J Panayiotou, C Dimakou
11st Dept. of Paediatrics, University of Athens, Athens, Greece.
Insights
Infliximab and adalimumab are effective and safe biological agents for pediatric inflammatory bowel disease (IBD). These anti-TNF-alpha therapies show good remission rates and reduce surgery needs in children with Crohn's disease.
Area of Science:
- Pediatric gastroenterology
- Immunology
- Pharmacology
Background:
- Biological agents, particularly anti-TNF-alpha therapies, have become crucial in managing inflammatory bowel disease (IBD) over the past 15 years.
- Pediatric IBD management requires careful consideration of efficacy and safety profiles of available biologic treatments.
Purpose of the Study:
- To evaluate the efficacy and safety of infliximab and adalimumab in pediatric patients with IBD.
- To analyze treatment outcomes, including remission rates, surgery-free survival, and adverse events, over a decade of use.
Main Methods:
- Retrospective analysis of 31 pediatric IBD patients treated with infliximab or adalimumab.
- Data collected included patient demographics, disease characteristics, treatment history, efficacy endpoints, and safety events.
- Mean age of patients was 13.5 years, with 74% diagnosed with Crohn's disease.
Main Results:
- Initial response to anti-TNF-alpha therapy was observed in 82.8% of patients, with a 53% remission rate at one year.
- Surgery-free survival rates at 12, 36, and 60 months were 89.6%, 89.6%, and 74.7%, respectively.
- Serious anaphylaxis occurred in 1.5% of infusions (12.3% of patients); steroid use decreased significantly after three months.
Conclusions:
- Anti-TNF-alpha agents like infliximab and adalimumab are valuable and safe therapeutic options for children with refractory IBD.
- Current data suggest satisfactory outcomes, but long-term efficacy and safety in pediatric populations require further investigation.
Objectives:
Biological agents have contributed significantly in controlling inflammatory bowel disease during the last 15 years. This study aimed at recording and evaluating paediatric data regarding the efficacy and safety of infliximab and adalimumab during the last decade.
Patients And Methods:
A total of 31 patients (43% males) with a mean age of 13.5 +/- 3.0 years were included and the majority (74%) had Crohn's disease (CD). Failure of previous treatment and steroid dependency were the main reasons for initiating anti-TNF-alpha therapy. Mean age at the first infusion was 11.0 +/- 2.8 years, while the mean disease duration at the introduction of infliximab was 2.6 +/- 2.7 years. The number of infusions per patient ranged from 1-25 (median 7, IQR: 4-13).
Results:
Initial response was achieved in 82.8% of patients. After one year of treatment the estimated rate of remission was 53%. The rate of surgery-free disease at 12, 36 and 60 months, after the first dose of infliximab, was 89.6%, 89.6% and 74.7% respectively. The incidence of serious anaphylaxis was 4/268 infusions (1.5%) or 4/31 patients (12.3%). At three months after the first infusion only 2 children were on steroids. Adalimumab was administered to 5 patients for a mean duration of 7.4 months, as a second option after infliximab failure or infusion reaction. Two out of five patients failed to achieve remission with adalimumab and these two patients were also infliximab failures.
Conclusion:
Biological agents are valuable and safe options for children with refractory IBD. The results, so far, have been satisfactory, although, long-term outcomes remain yet to be determined.
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