Response to Induction Therapy in a Pediatric Population of Inflammatory Bowel Disease

Zusammenfassung

Die Crohn-Krankheit (Morbus Crohn) und die Colitis ulcerosa sind 2 entzündliche Darmerkrankungen, charakterisiert durch eine chronische intestinale Entzündung. In dieser Studie wurden die klinischen Charakteristika einer Gruppe pädiatrischer Patienten mit entzündlicher Darmerkrankung überprüft und ihre Reaktionen auf die Induktionstherapie beurteilt. Für 43 Patienten (20 mit Morbus Crohn und 23 mit Colitis ulcerosa) wurde, gestützt auf die initiale Aktivität, mittels PCDAI und PUCAI die Heftigkeit der Erkrankung bestimmt und die Therapie eingeleitet. Anschließend wurde die Aktivität 6 Monate nach der ersten Diagnose noch einmal überprüft. Die Patienten beider Gruppen litten unter milder bis schwerer Erkrankung. Die durchschnittlichen PCDAI- und PUCAI-Werte betrugen 60,62 ± 16,48 und 50,95 ± 9,35, jeweils für Morbus-Crohn- bzw. Colitis-ulcerosa-Patienten. Die meisten Patienten (83,7 %) reagierten auf Standardbehandlungen mit signifikanter Reduktion der PCDAI- und PUCAI-Ergebnisse des Ausgangspunkts (p-Wert < 0,001). Am ursprünglichen Endpunkt von 24 Wochen waren 54 % aller Patienten in klinischer Remission; 16 von 23 in der Colitis-ulcerosa-Gruppe (70 %) und 6 von 20 in der Morbus-Crohn-Gruppe (30 %). Die Ergebnisse dieser Studie geben Klarheit darüber, dass die Einteilung pädiatrischer Patienten mit chronisch entzündlicher Darmerkrankung in unterschiedliche klinische Phänotypen, basierend auf der Aktivität der anfänglichen Symptomatik, Anhalt für ein besseres Management dieser Gruppe liefern und die Nebenwirkungen unnötiger Therapien reduzieren könnte.

Abstract

Crohn’s disease (CD) and ulcerative colitis (UC) are two inflammatory bowel diseases (IBD) characterized by chronic intestinal inflammation. In this study, the clinical characteristics of a cohort of pediatric patients with IBD are reviewed and their responses to induction therapy are evaluated. The severity of disease for 43 patients (20 with CD and 23 with UC) was determined using the PCDAI and PUCAI and based on the initial severity, before treatment was started. Following treatment, the severity of disease was re-evaluated at 6 months after the initial diagnosis. The patients in both groups had mild-to-severe disease. The mean PCDAI and PUCAI values were 60.62 ± 16.48 and 50.95 ± 9.35, for CD and UC patients, respectively. Most patients (83.7 %) responded to standard treatments with a significant reduction in the PCDAI and PUCAI scores from baseline (p value < 0.001). At the primary endpoint of 24 weeks, 54 % of all patients were in clinical remission; 16 of 23 in the UC group (70 %) and 6 of 20 in the CD group (30 %). The results of this study provide evidence that subgrouping pediatric patients with IBD into distinct clinical phenotypes based on severity of the initial presentation may provide better means of management of this group. This approach can result in a better response to treatment and reduce the side effects of unnecessary therapy.

Crohn-Krankheit (Morbus Crohn) - Colitis ulcerosa - entzündliche Darmerkrankung - Heftigkeit - Behandlung

Crohn’s disease - ulcerative colitis - inflammatory bowel diseases - severity - treatment

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