Effect of early immunomodulator use in moderate to severe pediatric Crohn disease
| Autor: | Anthony Otley, Jeffrey S. Hyams, Trudy Lerer, Anne M. Griffiths, Joel R. Rosh, Wallace Crandall, M. Susan Moyer, Marian Pfefferkorn, Maria Oliva-Hemker, Jaya Punati, David R. Mack, David J. Keljo, Subra Kugathasan, Jonathan Evans, Neal Leleiko, Athos Bousvaros, James Markowitz, Adam Mezoff, Robert Wyllie |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Moderate to severe medicine.medical_specialty medicine.drug_class Azathioprine Disease Inflammatory bowel disease Crohn Disease Gastrointestinal Agents Adrenal Cortex Hormones Internal medicine medicine Humans Immunologic Factors Immunology and Allergy Prospective Studies Child Crohn's disease Mercaptopurine business.industry Gastroenterology Antibodies Monoclonal medicine.disease Infliximab Surgery Hospitalization Corticosteroid Female Observational study business medicine.drug |
| Zdroj: | Inflammatory Bowel Diseases. 14:949-954 |
| ISSN: | 1078-0998 |
| Popis: | Background: The immunomodulators (IMs) 6-mercaptopurine and azathioprine decrease corticosteroid dependence and maintain remission in Crohn's disease (CD). We describe IM use in newly diagnosed pediatric CD, comparing outcomes of “early” versus “late” initiation of therapy. Methods: Data were obtained from pediatric CD patients enrolled in a prospective, multicenter observational study. Moderate/severe disease patients treated with IM were compared for outcomes of remission, corticosteroid use, infliximab therapy, hospitalizations, and CD-related surgery based on timing of initiation of IM therapy. Results: In all, 247 children met the criteria (60% male, mean age 11.9 years); 199 were treated with IM within 1 year of diagnosis; 150 between 0–3 months (early), 49 between 3–12 months (late). Both groups showed a decrease in corticosteroid use by 12 months, at which time proportionately fewer early group patients had received corticosteroids in the preceding quarter (22%) than late groups patients (41%)(P = 0.013). The number of hospitalizations per patient was also noted to be significantly lower in the early group over the 2-year follow-up (P = 0.03). No difference was noted in the rates of remission, infliximab use over time, or surgery. Conclusions: 80% of children with newly diagnosed moderate to severe CD are treated with IM within 1 year. Early IM use is associated with reduced corticosteroid exposure and possibly fewer hospitalizations per patient. (Inflamm Bowel Dis 2008) |
| Databáze: | OpenAIRE |
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