| Autor: |
Nambu, Ryusuke, Arai, Katsuhiro, Kudo, Takahiro, Murakoshi, Takatsugu, Kunisaki, Reiko, Mizuochi, Tatsuki, Kato, Sawako, Kumagai, Hideki, Inoue, Mikihiro, Ishige, Takashi, Saito, Takeshi, Noguchi, Atsuko, Yodoshi, Toshifumi, Hagiwara, Shin-Ichiro, Iwata, Naomi, Nishimata, Shigeo, Kakuta, Fumihiko, Tajiri, Hitoshi, Hiejima, Eitaro, Toita, Nariaki |
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| Zdroj: |
Journal of Gastroenterology; May2023, Vol. 58 Issue 5, p472-480, 9p |
| Abstrakt: |
Background: As best practices for treating children with severe-onset ulcerative colitis remain controversial in the era of biologic agents, we prospectively investigated treatments and outcomes in a multicenter cohort. Methods: Using a Web-based data registry maintained in Japan between October 2012 and March 2020, we compared management and treatment outcomes in an S1 group defined by a Pediatric Ulcerative Colitis Activity Index of 65 or more points at diagnosis with those in an S0 group defined by an index value below 65. Results: Three hundred one children with ulcerative colitis treated at 21 institutions were included, with follow-up for 3.6 ± 1.9 years. Among them, 75 (25.0%) were in S1; their age at diagnosis was 12.3 ± 2.9 years, and 93% had pancolitis. Colectomy free rates in S1 were 89% after 1 year, 79% after 2, and 74% after 5, significantly lower than for S0 (P = 0.0003). Calcineurin inhibitors and biologic agents, respectively, were given to 53% and 56% of S1 patients, significantly more than for S0 patients (P < 0.0001). Among S1 patients treated with calcineurin inhibitors when steroids failed, 23% required neither biologic agents nor colectomy, similarly to the S0 group (P = 0.46). Conclusions: Children with severe ulcerative colitis are likely to require powerful agents such as calcineurin inhibitors and biologic agents; sometimes colectomy ultimately proves necessary. Need for biologic agents in steroid-resistant patients might be reduced to an extent by interposing a therapeutic trial of CI rather than turning to biologic agents or colectomy immediately. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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