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Chinese Herbal Retention Enema for the Treatment of Ulcerative Colitis
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Chinese Herbal Retention Enema for the Treatment of Ulcerative Colitis

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Immunotherapy withdrawal by step-down to mesalamine in pediatric patients with ulcerative colitis

Reka Szigeti1, Richard Kellermayer2,3

  • 1Department of Pathology and Genomic Medicine Houston Methodist Hospital Houston Texas USA.

JPGN Reports
|May 17, 2024
PubMed

Insights

Stepping down ulcerative colitis (UC) treatment to mesalamine is a viable option for pediatric patients before adult care. This approach maintained remission in over half of patients studied, suggesting its potential effectiveness.

Area of Science:

  • Pediatric Gastroenterology
  • Inflammatory Bowel Disease Research
  • Clinical Therapeutics

Background:

  • Pediatric patients with ulcerative colitis (UC) on systemic immunotherapy face lifelong treatment risks.
  • Limited data exists on discontinuing immunotherapy and transitioning to enteral 5-aminosalicylic acid (mesalamine) in pediatric UC before adult care.

Purpose of the Study:

  • To evaluate the efficacy and safety of stepping down systemic immunotherapy to oral mesalamine in pediatric patients with moderate to severe UC.
  • To assess sustained clinical remission rates and markers of inflammation and healing after treatment step-down.

Main Methods:

  • Retrospective study of nine pediatric UC patients who achieved remission on systemic immunotherapy.
  • Patients were stepped down to oral mesalamine, with follow-up assessing clinical remission, fecal calprotectin, and mucosal healing.

Main Results:

  • Over half (55.5%) of patients maintained sustained clinical remission after stepping down to mesalamine.
  • Remission rates at 1, 2, and 3 years post-step-down were 88.9%, 87.5%, and 66.7%, respectively.
  • Significant proportions achieved fecal calprotectin normalization (62.5%) and mucosal healing (66.6%).

Conclusions:

  • Stepping down to mesalamine is a reasonable therapeutic strategy for pediatric UC patients prior to transitioning to adult gastroenterology care.
  • Shared decision-making is crucial when considering treatment modifications in pediatric UC.
Abstract

Keywords:
anti‐TNFde‐escalationinfliximabthiopurinestreatment

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