Efficacy and safety of adalimumab in the treatment of pediatric inflammatory bowel disease
10.3760/cma.j.cn101480-20201017-00120
- VernacularTitle:阿达木单克隆抗体治疗儿童炎症性肠病的疗效与安全性分析
- Author:
Youhong FANG
1
;
Youyou LUO
1
;
Jindan YU
1
;
Qi CHENG
1
;
Mingfang SUN
1
;
Jie CHEN
1
Author Information
1. 浙江大学医学院附属儿童医院消化科 国家儿童健康与疾病临床医学研究中心，杭州 310052
- Publication Type:Journal Article
- Keywords:
Inflammatory bowel disease;
Crohn′s disease;
Ulcerative colitis;
Child;
Adalimumab;
Efficacy;
Safety;
Infliximab;
Primary loss response;
Secondary loss respons
- From:
Chinese Journal of Inflammatory Bowel Diseases
2021;05(3):220-224
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the efficacy and safety of adalimumab in the treatment of pediatric inflammatory bowel disease (IBD) patients.Methods:Clinical data of pediatric IBD patients who switched to adalimumab therapy after the failure of infliximab in the Children′s Hospital, Zhejiang University School of Medicine from January 2019 to September 2020 were analyzed retrospectively. A descriptive method was used to analyze the general information, disease activity index and mucosal inflammation before and after the treatment of adalimumab. The pediatric Crohn′s disease activity index (PCDAI) and pediatric ulcerative colitis activity index (PUCAI) were used to evaluate the disease activity. The Crohn′s disease endoscopic index of severity (CDEIS) and ulcerative colitis endoscopic index of severity (UCEIS) were used to evaluate the mucosal inflammation.Results:A total of 10 children diagnosed with IBD were treated with adalimumab, including 9 patients of Crohn′s disease (CD) and 1 of ulcerative colitis (UC) . There were 6 males and 4 females, with disease onset age of 0.3 to 13.3 years and median duration of 38 (3 to 81) months before the treatment of adalimumab. In lesion location of 9 CD patients, 2 patients only involved the small intestine (L4a+L4b) and 7 patients involved the whole digestive tract (L3+L4a+L4b) according to Paris classification. The reasons of switching infliximab to adalimumab were as follows: primary loss response to infliximab occurred in 1 patient, secondary loss response to infliximab in 6 and severe anaphylaxis in 3. According to PCDAI and PUCAI, the clinical remission was achieved in 1, mild activity in 4, moderate in 3 and severe in 2 before the treatment of adalimumab. Clinical remission was achieved in 6, clinical response in 1 and non-response in 1 at the 10th week. After the median follow-up period of 25 (10 to 86) weeks, clinical remission was achieved in 8, the clinical symptom of 1 non-responsive patient was improved during the follow-up. The left 1 non-responsive patient stopped treatment of adalimumab and received gene sequencing test, and the results showed a hemizygote mutation of X-linked inhibitor of apoptosis protein ( XIAP) gene and the X-linked lymphocytic proliferation syndrome was considered. Five cases of side reaction occurred in 10 patients, mainly the respiratory infections, and no other serious side reactions occurred. Conclusion:Switching to adalimumab attains good outcome in pediatric IBD patients after the failure of infliximab.
