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| http://dx.doi.org/10.1093/ecco-jcc/jjv206 | DOI Listing |
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Clinical impacts of immunomodulator withdrawal from anti-tumor necrosis factor combination therapy in pediatric inflammatory bowel disease.
J Pediatr Gastroenterol Nutr
October 2024
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA.
Objectives: Combination therapy consists of both anti-tumor necrosis factor (anti-TNF) and an immunomodulator (IMM) and has been shown to improve outcomes in patients with inflammatory bowel disease (IBD). This study assesses the impacts of IMM withdrawal from combination therapy to anti-TNF monotherapy in children with IBD.
Methods: This single-center retrospective cohort study included children with IBD initiated on combination therapy between 2014 and 2019 who discontinued the IMM.
Immunotherapy withdrawal by step-down to mesalamine in pediatric patients with ulcerative colitis.
JPGN Rep
May 2024
Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital Baylor College of Medicine Houston Texas USA.
Objective: Parents and pediatric patients with ulcerative colitis (UC) who progressed to systemic immunotherapy are concerned about lifelong risks from such treatments. There is limited knowledge about withdrawal of such agents and step-down (SD) to enteral 5-aminosalicylic acid (mesalamine) before transitioning to adult care.
Methods: We studied nine pediatric cases with moderate to severe UC who after a median of 2.
Drug therapy in juvenile spondyloarthritis.
Curr Opin Rheumatol
July 2024
Division of Rheumatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Article Synopsis
- This review discusses recent advancements in treating juvenile spondyloarthritis, focusing on enthesitis-related arthritis and juvenile psoriatic arthritis.
- New biologic drugs beyond tumor necrosis factor inhibitors, such as IL-17 blockers and Janus kinase inhibitors, have shown promising safety and efficacy in clinical settings.
- There's an ongoing need for robust real-world data and registry studies to further understand the effectiveness of these treatments and to develop strategies for reducing medication dosages when appropriate.
Hyperbaric Oxygen Enabled a Transition to Oral Steroids in an Acute Severe Ulcerative Colitis Flare.
Crohns Colitis 360
April 2024
Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA.
Background: Ulcerative colitis (UC) is characterized in part by a dysregulated response to tissue hypoxia. While intravenous (IV) steroids are the mainstay of treatment for acute severe UC (ASUC), up to one-third of patients are refractory to steroids alone and require rescue therapy.
Case Description: A 71-year-old female with extensive UC on infliximab presented with abdominal pain and more than 10 bloody bowel movements per day.
De-escalation of Biologic Treatment in Inflammatory Bowel Disease: A Comprehensive Review.
J Crohns Colitis
April 2024
Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-Princesa], Universidad Autónoma de Madrid [UAM], Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain.
Article Synopsis
- Biologic therapy is a common and effective treatment for inflammatory bowel disease (IBD), but due to concerns about cost and safety, reducing doses after achieving remission is being considered.
- A review of existing research shows that while a significant percentage of patients undergo dose de-escalation after higher dosing, the overall relapse rates differ, with risks increasing when not all remission criteria are met.
- Decisions on de-escalation should be personalized, weighing the benefits against potential relapses, and more research is needed to assess the safety and effectiveness of this strategy, especially for treatments beyond anti-TNF therapies.
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