TY - JOUR
T1 - Clinical outcome of ulcerative colitis with severe onset in children
T2 - a multicenter prospective cohort study
AU - JPIBD-R
AU - Nambu, Ryusuke
AU - Arai, Katsuhiro
AU - Kudo, Takahiro
AU - Murakoshi, Takatsugu
AU - Kunisaki, Reiko
AU - Mizuochi, Tatsuki
AU - Kato, Sawako
AU - Kumagai, Hideki
AU - Inoue, Mikihiro
AU - Ishige, Takashi
AU - Saito, Takeshi
AU - Noguchi, Atsuko
AU - Yodoshi, Toshifumi
AU - Hagiwara, Shin Ichiro
AU - Iwata, Naomi
AU - Nishimata, Shigeo
AU - Kakuta, Fumihiko
AU - Tajiri, Hitoshi
AU - Hiejima, Eitaro
AU - Toita, Nariaki
AU - Mochizuki, Takahiro
AU - Shimizu, Hirotaka
AU - Iwama, Itaru
AU - Hirano, Yuri
AU - Shimizu, Toshiaki
N1 - Publisher Copyright:
© 2023, Japanese Society of Gastroenterology.
PY - 2023/5
Y1 - 2023/5
N2 - Background: As best practices for treating children with severe-onset ulcerative colitis remain controversial in the era of biologic agents, we prospectively investigated treatments and outcomes in a multicenter cohort. Methods: Using a Web-based data registry maintained in Japan between October 2012 and March 2020, we compared management and treatment outcomes in an S1 group defined by a Pediatric Ulcerative Colitis Activity Index of 65 or more points at diagnosis with those in an S0 group defined by an index value below 65. Results: Three hundred one children with ulcerative colitis treated at 21 institutions were included, with follow-up for 3.6 ± 1.9 years. Among them, 75 (25.0%) were in S1; their age at diagnosis was 12.3 ± 2.9 years, and 93% had pancolitis. Colectomy free rates in S1 were 89% after 1 year, 79% after 2, and 74% after 5, significantly lower than for S0 (P = 0.0003). Calcineurin inhibitors and biologic agents, respectively, were given to 53% and 56% of S1 patients, significantly more than for S0 patients (P < 0.0001). Among S1 patients treated with calcineurin inhibitors when steroids failed, 23% required neither biologic agents nor colectomy, similarly to the S0 group (P = 0.46). Conclusions: Children with severe ulcerative colitis are likely to require powerful agents such as calcineurin inhibitors and biologic agents; sometimes colectomy ultimately proves necessary. Need for biologic agents in steroid-resistant patients might be reduced to an extent by interposing a therapeutic trial of CI rather than turning to biologic agents or colectomy immediately.
AB - Background: As best practices for treating children with severe-onset ulcerative colitis remain controversial in the era of biologic agents, we prospectively investigated treatments and outcomes in a multicenter cohort. Methods: Using a Web-based data registry maintained in Japan between October 2012 and March 2020, we compared management and treatment outcomes in an S1 group defined by a Pediatric Ulcerative Colitis Activity Index of 65 or more points at diagnosis with those in an S0 group defined by an index value below 65. Results: Three hundred one children with ulcerative colitis treated at 21 institutions were included, with follow-up for 3.6 ± 1.9 years. Among them, 75 (25.0%) were in S1; their age at diagnosis was 12.3 ± 2.9 years, and 93% had pancolitis. Colectomy free rates in S1 were 89% after 1 year, 79% after 2, and 74% after 5, significantly lower than for S0 (P = 0.0003). Calcineurin inhibitors and biologic agents, respectively, were given to 53% and 56% of S1 patients, significantly more than for S0 patients (P < 0.0001). Among S1 patients treated with calcineurin inhibitors when steroids failed, 23% required neither biologic agents nor colectomy, similarly to the S0 group (P = 0.46). Conclusions: Children with severe ulcerative colitis are likely to require powerful agents such as calcineurin inhibitors and biologic agents; sometimes colectomy ultimately proves necessary. Need for biologic agents in steroid-resistant patients might be reduced to an extent by interposing a therapeutic trial of CI rather than turning to biologic agents or colectomy immediately.
UR - http://www.scopus.com/inward/record.url?scp=85149703217&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85149703217&partnerID=8YFLogxK
U2 - 10.1007/s00535-023-01972-1
DO - 10.1007/s00535-023-01972-1
M3 - Article
C2 - 36884071
AN - SCOPUS:85149703217
SN - 0944-1174
VL - 58
SP - 472
EP - 480
JO - Journal of Gastroenterology
JF - Journal of Gastroenterology
IS - 5
ER -