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1.
J Pediatr Gastroenterol Nutr ; 73(5): 610-614, 2021 11 01.
Article in English | MEDLINE | ID: mdl-34415711

ABSTRACT

INTRODUCTION: Ustekinumab (UST), a human monoclonal antibody against interleukin-12 and 23, is approved to treat adult patients with psoriasis or Crohn disease (CD). Outcomes data for off-label use in pediatric patients with CD are limited. AIM: We conducted a retrospective cohort study to analyze the long-term efficacy of UST, including dose adjustments, in the treatment of pediatric patients with medically refractory CD. Adverse events were documented. METHODS: We identified 40 pediatric patients with CD treated with UST between January 1, 2016 and December 31, 2019. Electronic medical records were reviewed for demographics, Paris Classification, significant comorbidities, previous CD therapy, adverse events after initiation, and surveillance markers at the time of their first dose and most recent clinic visit. A validated abbreviated pediatric CD activity index (aPCDAI) was used to assess response to therapy. RESULTS: Thirty-eight pediatric patients with CD, including 34.2% with stricturing or penetrating disease, were analyzed after initiation of treatment with UST. Median age at diagnosis of CD was 12.5 years, and median age at UST induction was 17.2 years. No patients were anti-TNF-naive, and 34.2% were previously exposed to 2 or more anti-TNF agents. At time of last follow-up, 84.2% of patients remained on UST for a median duration on UST of 62.1 weeks, and 60.5% achieved clinical remission. Patients had significant improvement in aPCDAI scores, clinical remission rates, albumin, and hematocrit, and 89.5% of patients had no significant adverse events. Similar results were observed among those who required dose adjustment, including 61.1% achieving clinical remission, and among those with perianal disease, including 38.5% achieving clinical remission. CONCLUSIONS: Our data suggest that, within our cohort of pediatric patients with CD, UST has long-term efficacy with no observed safety concerns. Dose adjustment may be helpful in achieving clinical remission.


Subject(s)
Crohn Disease , Ustekinumab , Adult , Antibodies, Monoclonal , Child , Crohn Disease/drug therapy , Humans , Retrospective Studies , Tumor Necrosis Factor Inhibitors , Ustekinumab/therapeutic use
2.
S Afr Med J ; 100(7): 445-8, 2010 Jul 05.
Article in English | MEDLINE | ID: mdl-20822592

ABSTRACT

BACKGROUND: Anaemia has been reported to affect 20 - 75% of children in South Africa. The range suggests the effects that geography, health, and socio-economic status can have on the observed prevalence of anaemia within a specific community. Our objective was to investigate the prevalence of anaemia in children aged under 5 presenting for well-child examinations at a community health centre in Thohoyandou, Limpopo Province. DESIGN: A cross-sectional observational study was carried out in June and July 2007. Caregivers participated in a brief interview where demographic, health, and nutritional information was collected. A blood sample was collected from each child, and haemoglobin levels were assessed with a point-of-care haemoglobin testing system. Anaemia was defined as having a haemoglobin value <2 standard deviations below age-altitude adjusted normal values. RESULTS: Three-quarters (39/52 - 75%) of children were anaemic. Girls were significantly more likely to be anaemic than boys (20/20 v. 19/32 respectively; p=0.001). Anaemic children were significantly less likely to be underweight compared with their peers (32/38 v. 5/12 respectively; p=0.007). There was no significant association between anaemia and infection with Helicobacter pylori (p=0.729), intestinal helminths (p=1.000) or food insecurity (p=0.515). CONCLUSION: We found a striking prevalence of anaemia among clinically well children <5 years old in Thohoyandou, Limpopo Province. The rates of anaemia were higher than those found in previous studies conducted in similar settings in South Africa. Future work should focus on aetiologies and interventions.


Subject(s)
Anemia/epidemiology , Child, Preschool , Community Health Centers , Cross-Sectional Studies , Female , Follow-Up Studies , Hemoglobinometry/methods , Humans , Male , South Africa/epidemiology
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