Immunotherapy withdrawal by step‐down to mesalamine in pediatric patients with ulcerative colitis

JPGN reports Pub Date : 2024-02-05 DOI:10.1002/jpr3.12048
R. Szigeti, R. Kellermayer
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引用次数: 1

Abstract

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.We studied nine pediatric cases with moderate to severe UC who after a median of 2.18 years of clinical remission on systemic immunotherapy stepped down to oral mesalamine treatment.Average follow‐up time from SD was 3.49 years. Five patients (55.5%) had sustained remission (without any flare noted) after SD during follow‐up. Sustained clinical remission was 88.9% (8/9) at 1 year, 87.5% (7/8) at 2 years, and 66.7% (4/6) at 3 years after SD. Out of those tested (one patient was not tested), 62.5% (5/8) had fecal calprotectin <50 μg/g. Four out of six patients examined (66.6%) had mucosal healing on post‐SD colonoscopy.We propose that SD to mesalamine can be a reasonable therapeutic consideration for pediatric patients with UC before transitioning to adult gastroenterology care. Shared decision‐making is important before such treatment changes.
儿科溃疡性结肠炎患者逐步停用美沙拉嗪后的免疫疗法
家长和接受全身免疫疗法的溃疡性结肠炎(UC)儿科患者担心这种治疗会带来终身风险。我们研究了 9 例中度至重度 UC 儿童患者,他们在接受全身免疫疗法临床缓解中位数为 2.18 年后,转而接受口服美沙拉明治疗。从SD开始的平均随访时间为3.49年。随访期间,有5名患者(55.5%)在SD后获得了持续缓解(无任何复发迹象)。SD后1年的持续临床缓解率为88.9%(8/9),2年为87.5%(7/8),3年为66.7%(4/6)。在接受检查的患者中(一名患者未接受检查),62.5%(5/8)的粪便钙蛋白<50 μg/g。在接受 SD 后结肠镜检查的六名患者中,有四名患者(66.6%)的粘膜已经愈合。我们建议,对于患有 UC 的儿科患者,在过渡到成人胃肠病治疗之前,将 SD 转为美沙拉明是一种合理的治疗考虑。在改变治疗方案之前,共同决策非常重要。
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