Predictors of Long-term Clinical and Endoscopic Remission in Children With Crohn Disease Treated With Infliximab.
J Pediatr Gastroenterol Nutr
; 68(6): 841-846, 2019 06.
Article
em En
| MEDLINE
| ID: mdl-30633110
ABSTRACT
OBJECTIVES:
We aimed to identify early noninvasive predictors of clinical and endoscopic remission in children with Crohn disease (CD) under infliximab (IFX).METHODS:
Prospective observational study conducted in children with moderate-to-severe CD starting IFX. All patients underwent weighted pediatric CD activity index (wPCDAI) assessment, C-reactive protein and fecal calprotectin (FC) at week 0, 14, and 48. Endoscopy was performed at 0 and 48 weeks. The primary outcome was to determine the ability of 14-week wPCDAI, C-reactive protein, and FC to predict 1-year steroid-free clinical remission and mucosal healing. As a secondary outcome we evaluated their concordance with Simple Endoscopic Score for CD (SES-CD) at week 48.RESULTS:
Forty-one children were enrolled. At 1 year, 21 (51%) and 16 (39%) were in clinical and endoscopic remission. Only combined postinduction FC and wPCDAI were able to predict 1-year clinical and endoscopic remission (hazard ratio 4.81 [95% confidence interval 1.76-20.45], Pâ=â0.05 and hazard ratio 5.51 [95% confidence interval 1.83-26.9], Pâ=â0.03). One-year SES-CD moderately correlated with FC (râ=â0.52; Pâ=â0.001). The FC cut-off value for mucosal healing was 120.5âµg/g (area under the curve 0.863, 83% sensitivity, 75.5% specificity; Pâ=â0.005). The concordance between wPCDAI and SES-CD was excellent and good for severe disease and remission (k 0.87 and 0.76).CONCLUSIONS:
Post induction FC combined with wPCDAI can predict 1-year clinical and endoscopic response to IFX in pediatric CD. FC shows a moderate correlation with SES-CD, whereas wPCDAI has a good concordance with endoscopic remission or severe disease, but not with mild and moderate disease.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fármacos Gastrointestinais
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Doença de Crohn
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Colonoscopia
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Monitoramento de Medicamentos
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Infliximab
Tipo de estudo:
Diagnostic_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
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Child
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Female
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Humans
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Male
Idioma:
En
Revista:
J Pediatr Gastroenterol Nutr
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Itália