Antagonistas del factor de necrosis tumoral (TNF) en la enfermedad inflamatoria intestinal pediátrica: Una revisión sistemática / Tumour necrosis factor (TNF) antagonist therapy for paediatric inflammatory bowel disease: A systematic review

La enfermedad inflamatoria intestinal incluye 2 enfermedades crónicas inflamatorias, la colitis ulcerosa y la enfermedad de Crohn. Su carga de enfermedad está aumentando en el mundo. Se han publicado algunas revisiones que evalúan el uso pediátrico de los antagonistas del factor de necrosis tumoral (TNF), aunque incluyen mayoritariamente estudios observacionales y no consideran las evaluaciones económicas. En esta revisión sistemática se evalúa la evidencia disponible en cuanto a eficacia, seguridad y coste-efectividad de los antagonistas del TNF en el tratamiento de la enfermedad inflamatoria intestinal pediátrica. Se realizaron búsquedas en PubMed/MEDLINE, Embase y Cochrane Central (hasta mayo de 2022). Se incluyeron 9 ensayos clínicos aleatorizados y 4 evaluaciones económicas que estudiaran alguno de los fármacos anti-TNF (infliximab, adalimumab, golimumab, certolizumab) frente a diferentes alternativas. En los estudios que evaluaron la eficacia del tratamiento anti-TNF en enfermedad de Crohn, la mayoría valoraron la pauta de mantenimiento en pacientes que previamente habían respondido a la inducción (respuesta=28-63%, y remisión clínica=17-83% dependiendo de la dosis, fármaco y seguimiento). En colitis ulcerosa, el tratamiento de mantenimiento con anti-TNF presentó tasas de remisión clínica entre 17-44%. Nueve estudios mostraron información sobre acontecimientos adversos. No se encontraron ensayos clínicos que compararan diferentes fármacos anti-TNF. Los resultados de esta revisión indican que el tratamiento de mantenimiento con fármacos anti-TNF (como infliximab y adalimumab) en la enfermedad inflamatoria intestinal pediátrica es probablemente eficaz y seguro. Sin embargo, las evaluaciones económicas incluidas presentaron resultados contradictorios sobre las razones coste-efectividad (AU)

Inflammatory bowel disease includes two chronic inflammatory diseases, ulcerative colitis and Crohn's disease. The burden of disease is increasing worldwide. A few reviews evaluating the paediatric use of tumour necrosis factor (TNF) antagonists have been published, although these mostly include observational studies and do not consider economic evaluations. This systematic review evaluated the available evidence regarding the efficacy, safety, and cost-effectiveness of TNF antagonist therapy for paediatric inflammatory bowel disease. We searched PubMed/MEDLINE, Embase, and Cochrane Central (up to May 2022). Nine randomized clinical trials and four economic evaluations that examined any anti-TNF drugs (e.g., infliximab, adalimumab, golimumab, and certolizumab) against different alternatives were included. In studies evaluating the efficacy of anti-TNF drugs in Crohn's disease, most assessed the efficacy of maintenance regimen in patients who had previously responded to induction (response=28%–63%, and clinical remission=17%–83% depending on dose, drug, and follow-up). In ulcerative colitis, maintenance treatment with anti-TNF drugs reported clinical remission rates between 17% and 44%. Nine studies reported information on adverse events. No clinical trials comparing different anti-TNF drugs were found. The findings from this review suggest that maintenance treatment with anti-TNF drugs (such as infliximab and adalimumab) in paediatric inflammatory bowel disease is probably effective and safe. However, the economic evaluations reported contradictory results of the cost-effectiveness ratios (AU)

[Tumour necrosis factor (TNF) antagonist therapy for paediatric inflammatory bowel disease: A systematic review]. / Antagonistas del factor de necrosis tumoral (TNF) en la enfermedad inflamatoria intestinal pediátrica: Una revisión sistemática.

Inflammatory bowel disease includes two chronic inflammatory diseases, ulcerative colitis and Crohn's disease. The burden of disease is increasing worldwide. A few reviews evaluating the paediatric use of tumour necrosis factor (TNF) antagonists have been published, although these mostly include observational studies and do not consider economic evaluations. This systematic review evaluated the available evidence regarding the efficacy, safety, and cost-effectiveness of TNF antagonist therapy for paediatric inflammatory bowel disease. We searched PubMed/MEDLINE, Embase, and Cochrane Central (up to May 2022). Nine randomized clinical trials and four economic evaluations that examined any anti-TNF drugs (e.g., infliximab, adalimumab, golimumab, and certolizumab) against different alternatives were included. In studies evaluating the efficacy of anti-TNF drugs in Crohn's disease, most assessed the efficacy of maintenance regimen in patients who had previously responded to induction (response=28%-63%, and clinical remission=17%-83% depending on dose, drug, and follow-up). In ulcerative colitis, maintenance treatment with anti-TNF drugs reported clinical remission rates between 17% and 44%. Nine studies reported information on adverse events. No clinical trials comparing different anti-TNF drugs were found. The findings from this review suggest that maintenance treatment with anti-TNF drugs (such as infliximab and adalimumab) in paediatric inflammatory bowel disease is probably effective and safe. However, the economic evaluations reported contradictory results of the cost-effectiveness ratios. Protocol registry: Open Science Framework: https://osf.io/wjmvf.

Signo de la cuerda de Kantor en paciente con brote de enfermedad de Crohn / String sign of Kantor in a patient with Crohn's disease

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String sign of Kantor in a patient with Crohn's disease.

We report the case of a 29-year-old male with structuring ileocolic Crohn's disease (CD), diagnosed in 2007 and treated with oral azathioprine, oral mesalazine and intravenous infliximab, without any other surgical or medical history of interest. He presented to the Emergency Room with abdominal distention and pain, nausea, vomiting and motility problems of a three-day duration. An abdominal computerized tomography using intravenous contrast was performed.