Real-life Anti-tumor Necrosis Factor Experience in More Than 500 Patients: High Co-immunosuppression Rates But Low Rates of Quantifying Treatment Response
| Autor: | Franco Torrente, Mary-Anne Morris, Nicholas M. Croft, H. R. Jenkins, Kajal Mortier, Victoria Merrick, Mike Cosgrove, Mamoun Elawad, Anthony K Akobeng, Richard K. Russell, Charles Pj Charlton, Babu Vadamalayan, Astor Rodrigues, Rafeeq Muhammed, John Fell, Sonny K. F. Chong, S Loganathan, Veena Zamvar, Marcus K.H. Auth, R Mark Beattie, Sally G. Mitton, Linda Williams, Mark Furman, David C. Wilson |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Necrosis Adolescent Antibodies Monoclonal Humanized Inflammatory bowel disease Severity of Illness Index 03 medical and health sciences 0302 clinical medicine Disease severity Gastrointestinal Agents Paediatric gastroenterology Internal medicine medicine Humans Prospective Studies Child Immunosuppression Therapy Crohn's disease Clinical Audit business.industry Tumor Necrosis Factor-alpha Anti tumour necrosis factor Remission Induction Gastroenterology Infant medicine.disease Inflammatory Bowel Diseases Ulcerative colitis United Kingdom Surgery Treatment Outcome 030220 oncology & carcinogenesis Child Preschool Pediatrics Perinatology and Child Health 030211 gastroenterology & hepatology Tumor necrosis factor alpha Female medicine.symptom business |
| Zdroj: | Journal of pediatric gastroenterology and nutrition. 66(2) |
| ISSN: | 1536-4801 |
| Popis: | The aim of this study was to measure the effectiveness, safety, and use of anti-tumor necrosis Factor (TNF) therapy in pediatric inflammatory bowel disease in the United Kingdom (UK).Prospective UK audit of patients newly starting anti-TNF therapy. Disease severity was assessed using Physician Global Assessment +/or the Paediatric Crohn Disease Activity Index.A total of 37 centers participated (23/25 specialist pediatric inflammatory bowel disease sites). A total of 524 patients were included: 429 with Crohn disease (CD), 76 with ulcerative colitis (UC), and 19 with IBD unclassified (IBDU). Eighty-seven percent (488/562) of anti-TNF was infliximab; commonest indication was active luminal CD 77% (330/429) or chronic refractory UC/IBDU 56% (53/95); 79% (445/562) had concomitant co-immunosuppression. In CD (267/429 male), median time from diagnosis to treatment was 1.42 years (interquartile range 0.63-2.97). Disease (at initiation) was moderate or severe in 91% (156/171) by Physician Global Assessment compared to 41% (88/217) by Paediatric Crohn Disease Activity Index (Kappa (κ) 0.28 = only "fair agreement"; P 0.001.Where documented, 77% (53/69) of patients with CD responded to induction; and 65% (46/71) entered remission. A total of 2287 infusions and 301.96 years of patient' follow-up (n = 385) are represented; adverse events affected 3% (49/1587) infliximab and 2% (2/98) adalimumab infusions (no deaths or malignancies). Peri-anal abscess drainage was less common after anti-TNF initiation (CD), that is 26% (27/102) before, 7% (3/42) after (P = 0.01); however, pre and post anti-TNF data collection was not over equal time periods.Anti-TNFs are effective treatments, usually given with thiopurine co-immunosuppression. This study highlights deficiencies in formal documentation of effect and disparity between disease severity scoring tools, which need to be addressed to improve ongoing patient care. |
| Databáze: | OpenAIRE |
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