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BACKGROUND: We aimed to evaluate the predictors of sustainability of biologic drugs for paediatric patients with Crohn's disease (CD). METHODS: The Czech National Prospective Registry of Biologic and Targeted Therapy of Inflammatory Bowel Disease (CREdIT) was used to identify the biologic treatment courses in paediatric patients with CD. Mixed-effects Cox models and propensity score analyses were employed to evaluate predictors of treatment sustainability. RESULTS: Among the 558 observations of 473 patients, 264 were treated with adalimumab (47%), 240 with infliximab (43%), 41 with ustekinumab (7%), and 13 with vedolizumab (2%). Multivariable analysis revealed higher discontinuation risk with infliximab compared to adalimumab (HR = 0.600, 95%CI 0.389-0.926), both overall and in first-line treatment (HR = 0.302, 95%CI 0.103-0.890). Infliximab versus adalimumab was associated with shorter time to escalation (HR = 0.094, 95%CI 0.043-0.203). Propensity-score analysis demonstrated lower sustainability of infliximab (HR = 0.563, 95%CI 1.159-2.725). The time since diagnosis to treatment initiation (HR = 0.852, 95%CI 0.781-0.926) was the most important predictor. Baseline immunosuppressive therapy prolonged sustainability with infliximab (HR = 2.899, 95%CI 1.311-6.410). CONCLUSIONS: Given the results suggesting shorter sustainability, the need for earlier intensification and thus higher drug exposure, and the greater need for immunosuppression with infliximab than with adalimumab, the choice of these drugs cannot be considered completely equitable. IMPACT: Our study identified predictors of sustainability of biologic treatment in paediatric patients with Crohn's disease, including adalimumab (versus infliximab), early initiation of biologic treatment, and normalised baseline haemoglobin levels. Infliximab treatment was associated with earlier intensification, higher drug exposure, and a greater need for immunosuppression. Parents and patients should be fully informed of the disadvantages of intravenous infliximab versus adalimumab during the decision-making process. This study emphasises the importance of not delaying the initiation of biologic therapy in paediatric patients with Crohn's disease.
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INTRODUCTION: Post-inflammatory pseudopolyps (PIPs) develop in connection with an inflammatory process in the bowel. Masses larger than 15 mm are classified as giant PIPs. They are very rare, especially in children. PRESENTATION OF CASE: A case of 13-year-old girl suffering from ulcerative colitis (UC) and treated with corticosteroids and azathioprine is reported. Colonoscopic examination after achieving clinical remission revealed multiple giant PIPs. During endoscopic surveillance subsequent spontaneous regression of pseudopolyps was documented. DISCUSSION: Patients with prolonged relapses of inflammatory bowel disease (IBD) are predisposed to PIPs. Giant PIPs may be related to post inflammatory mucosal regeneration or hyperplastic proliferation of the colonic mucosa between ulcerations after recurrent acute disease flares. Partial regression of giant polyps is uncommon, but has been reported. Some of these pseudopolyps are suitable for endoscopic polypectomy, but resection of PIPs is not generally advisable, because they usually regrow. Surgical intervention is advocated in symptomatic cases such as those with abdominal pain, severe hemorrhage or intestinal obstruction. CONCLUSION: The present case report of giant PIPs in an adolescent girl describes rare course of severe ulcerative colitis complicated by development of multiple giant PIPs. Due to asymptomatic course of the disease a conservative therapeutic approach was decided upon. Gradual regression of giant PIPs was observed during consecutive several year surveillance.