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2 results on '"Paquot I"'

1. Long-term Outcomes with Anti-TNF Therapy and Accelerated Step-up in the Prospective Pediatric Belgian Crohn's Disease Registry (BELCRO).

Author

Wauters L, Smets F, De Greef E, Bontems P, Hoffman I, Hauser B, Alliet P, Arts W, Peeters H, Van Biervliet S, Paquot I, Van de Vijver E, De Vos M, Bossuyt P, Rahier JF, Dewit O, Moreels T, Franchimont D, Muls V, Fontaine F, Louis E, Coche JC, Baert F, Paul J, Vermeire S, and Veereman G

Subjects
Adolescent, Age Factors, Belgium, Child, Drug Administration Schedule, Female, Follow-Up Studies, Humans, Induction Chemotherapy methods, Male, Prospective Studies, Registries, Time Factors, Treatment Outcome, Crohn Disease drug therapy, Gastrointestinal Agents administration & dosage, Severity of Illness Index, Tumor Necrosis Factor-alpha antagonists & inhibitors
Abstract

Background: Accelerated step-up or anti-tumor necrosis factor (TNF) before first remission is currently not recommended in pediatric Crohn's disease., Methods: Five-year follow-up data from a prospective observational cohort of children diagnosed with Crohn's disease in Belgium were analyzed. Disease severity was scored as inactive, mild, or moderate to severe. Remission or inactive disease was defined as sustained if lasting ≥2 years. Univariate analyses were performed between anti-TNF-exposed versus naive patients and anti-TNF before versus after first remission and correlations assessed with primary outcomes average disease severity and sustained remission., Results: A total of 91 patients (median [IQR] age 12.7 [10.9-14.8] yrs, 53% male) were included. Disease location was 12% L1, 23% L2, and 64% L3 with 76% upper gastrointestinal and 30% perianal involvement. Disease severity was 25% mild and 75% moderate to severe. Of 66 (73%) anti-TNF-exposed patients, 34 (52%) had accelerated step-up. Anti-TNF use was associated with age (13.1 [11.5-15.2] versus 11.8 [8.7-13.8] yrs; P < 0.05), L2 (29% versus 8%; P = 0.04), and average disease severity (1.7 [1.4-1.9] versus 1.4 [1.3-1.6]; P < 0.001). Duration of anti-TNF correlated with average disease severity (r = 0.32, P = 0.002). Accelerated step-up was also associated with age (13.3 [12.1-15.9] versus 12.5 [10.2-14.1]; P = 0.02) and average disease severity (1.8 [1.6-1.9] versus 1.6 [1.3-1.8]; P = 0.002). Duration of sustained remission was similar in all patients, and no serious infections, cancer, or deaths were reported., Conclusions: Anti-TNF therapy and accelerated step-up in older patients with more severe disease leads to beneficial long-term outcomes.

Published
2017
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2. Safety and cost of infliximab for the treatment of Belgian pediatric patients with Crohn's disease

Author

Greef, E., Hoffman, I., D Haens, G., Stephanie Van Biervliet, Smets, F., Scaillon, M., Dewit, O., Peeters, H., Paquot, I., Alliet, P., Arts, W., Hauser, B., Vermeire, S., Gossum, A., Rahier, J. F., Etienne, I., Louis, E., Coche, J. C., Mahachie John, J., Steen, K., Veereman, G., UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - (MGD) Service de gastro-entérologie, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, UCL - (SLuc) Service de gastro-entérologie, and UCL - (SLuc) Service d'anatomie pathologique

Subjects
Male, Adolescent, Drug-Related Side Effects and Adverse Reactions, Medication Therapy Management, Antibodies, Monoclonal, Infliximab, Pharmacovigilance, Treatment Outcome, Belgium, Cost of Illness, Crohn Disease, Gastrointestinal Agents, Withholding Treatment, Medicine and Health Sciences, Humans, Female, Drug Monitoring, Child, Infusions, Intravenous
Abstract

Biologicals have become an important component in the treatment of Crohn's disease in children. Their increased and long term use raises safety concerns. We describe safety and cost of infliximab in Belgian pediatric Crohn's disease patients. All patients on infliximab as part of the present or past treatment for Crohn's Disease until January 1st 2011 were selected from an existing database. Information on disease phenotype, medication and adverse events were extracted. Adverse events occurred in 25.9% of patients exposed to infliximab of which 29.6% were severe. In total 31.7% of patients stopped infliximab therapy. The main reasons for discontinuation were adverse events in 45.4% and loss of response in 30.3%. No malignancies or lethal complications occurred over this 241 patient year observation period. Immunomodulators were concomitant medication in 75% of patients and were discontinued subsequently in 38.4% of them. The cost of infliximab infusions per treated patient per year in the Belgian health care setting is approximately 9 474 euro, including only medication and hospital related costs. Even though infliximab is relatively safe in pediatric CD on the short term, close follow-up and an increased awareness of the possible adverse reactions is highly recommended. Adverse reactions appeared in 25.9% of all patients and were the main reason for discontinuation. Treatment cost has to be balanced against efficacy and modifications in disease course. In the Belgian health care system, the medication is available to all patients with moderate to severe CD.

Published
2012

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