用于治疗儿科克罗恩病的瘤缩因子-α对抗剂
Andrea Sepúlveda1, Maria Jose de la Piedra Bustamante1, Esther Orlanski-Meyer2
1Department of Gastroenterology and Nutrition, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
儿科克朗氏病 (CD) 用抗瘤缩因子 (TNF) 治疗的治疗显示出潜在的益处. 一项试验表明,一线infliximab (FL-IFX) 可能会改善缓解率,但由于偏差很高,需要更多的研究.
科学领域:
- 胃肠病学 胃肠病学
- 儿科胃肠病学 儿科胃肠病学
- 免疫学 免疫学 免疫学
背景情况:
- 儿科克罗恩病 (CD) 发病率正在上升,经常呈现出侵略性,需要早期免疫调节.
- 抗瘤坏死因子 (TNF) 抗体有效地实现了CD的粘膜愈合.
- 关于儿科患者的最佳抗TNF剂量,时间和治疗策略 (自上而下与逐步上升) 的未解答问题仍然存在.
研究的目的:
- 评估TNF-α对抗剂在儿童克罗恩病中诱导缓解的疗效和安全性.
- 评估抗TNF治疗在患有活性CD的儿童和青少年中的益处和危害.
主要方法:
- 随机对照试验 (RCT) 的系统审查,没有语言或文档类型的限制.
- 搜索了多个数据库,包括Cochrane图书馆,PubMed,Embase,LILACS和Web of Science,截至2024年6月1日.
- 包括评估TNF-α对抗剂诱导儿科CD缓解的RCT;使用Cochrane的RoB 1工具评估偏差风险.
主要成果:
- 只有一个RCT符合纳入标准,涉及100名中度至重度CD的儿童;这项试验存在高偏差风险.
- 与传统治疗相比,一线infliximab (FL-IFX) 显示出更高的临床缓解 (59%对34%) 和内镜缓解 (59%对17%) 的趋势 (低确定性证据).
- 包含的研究没有报告所有原因的死亡率,发病率或严重不良事件.
结论:
- 有限的证据支持抗TNF疗法用于儿科CD缓解诱导,一项高风险偏差试验表明FL-IFX的潜在益处.
- 结果必须谨慎解释;需要进一步的大规模RCT,遵循CONSORT和SPIRIT指南.
- 需要更多的研究来回答关于在儿科CD中最佳抗TNF治疗时间,剂量和策略选择的关键问题.
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