PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
摘要：
患有溃疡性结肠炎（UC）的父母和儿童患者进展为全身免疫疗法，他们担心此类治疗的终身风险。在过渡到成人护理之前，关于停用此类药物和逐步降低（SD）至肠内5-氨基水杨酸（美沙拉嗪）的知识有限。
我们研究了9例中度至重度UC的儿科病例，这些病例在接受全身免疫疗法的中位临床缓解时间为2.18年后，逐渐转向口服美沙拉嗪治疗。
■从SD开始的平均随访时间为3.49年。随访期间，5例患者（55.5％）在SD后持续缓解（无任何耀斑）。1年持续临床缓解率为88.9%（8/9），87.5%（7/8）在2年，SD后3年为66.7%(4/6)。在接受测试的患者中（一名患者未接受测试），62.5%(5/8)的粪便钙卫蛋白<50μg/g。在SD结肠镜检查后，接受检查的六名患者中有四名（66.6％）的粘膜愈合。
■我们建议，在过渡到成人胃肠病学治疗之前，SD对美沙拉嗪的治疗可以是小儿UC患者的合理治疗考虑。在这种治疗改变之前，共同的决策很重要。
我们研究了9例中度至重度UC的儿科病例，这些病例在接受全身免疫疗法的中位临床缓解时间为2.18年后，逐渐转向口服美沙拉嗪治疗。
■从SD开始的平均随访时间为3.49年。随访期间，5例患者（55.5％）在SD后持续缓解（无任何耀斑）。1年持续临床缓解率为88.9%（8/9），87.5%（7/8）在2年，SD后3年为66.7%(4/6)。在接受测试的患者中（一名患者未接受测试），62.5%(5/8)的粪便钙卫蛋白<50μg/g。在SD结肠镜检查后，接受检查的六名患者中有四名（66.6％）的粘膜愈合。
■我们建议，在过渡到成人胃肠病学治疗之前，SD对美沙拉嗪的治疗可以是小儿UC患者的合理治疗考虑。在这种治疗改变之前，共同的决策很重要。
