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- Title
Clinical outcome of ulcerative colitis with severe onset in children: a multicenter prospective cohort study.
- Authors
Nambu, Ryusuke; Arai, Katsuhiro; Kudo, Takahiro; Murakoshi, Takatsugu; Kunisaki, Reiko; Mizuochi, Tatsuki; Kato, Sawako; Kumagai, Hideki; Inoue, Mikihiro; Ishige, Takashi; Saito, Takeshi; Noguchi, Atsuko; Yodoshi, Toshifumi; Hagiwara, Shin-Ichiro; Iwata, Naomi; Nishimata, Shigeo; Kakuta, Fumihiko; Tajiri, Hitoshi; Hiejima, Eitaro; Toita, Nariaki
- Abstract
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.
- Subjects
JAPAN; ULCERATIVE colitis; BIOLOGICALS; COHORT analysis; TREATMENT effectiveness; LONGITUDINAL method; ISCHEMIC colitis
- Publication
Journal of Gastroenterology, 2023, Vol 58, Issue 5, p472
- ISSN
0944-1174
- Publication type
Article
- DOI
10.1007/s00535-023-01972-1