Publication Date
5-1-2024
Journal
JPGN Reports
DOI
10.1002/jpr3.12048
PMID
38756120
PMCID
PMC11093912
PubMedCentral® Posted Date
2-5-2024
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
anti‐TNF, de‐escalation, infliximab, thiopurines, treatment
Abstract
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 2.18 years of clinical remission on systemic immunotherapy stepped down to oral mesalamine treatment.
RESULTS: 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.
CONCLUSION: 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.
Included in
Digestive System Diseases Commons, Gastroenterology Commons, Immunotherapy Commons, Medical Sciences Commons, Pediatrics Commons