Endoscopic and Histologic Healing in Children With Inflammatory Bowel Diseases Treated With Thalidomide | SNFGE.org - Société savante médicale française d'hépato-gastroentérologie et d’oncologie digestive
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Thématique :
- MICI
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Intermédiaire
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Intermédiaire
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Dans certains cas
 
 
Nom du veilleur :
Docteur Stéphane NAHON
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Clinical Gastroenterology and Hepatology
  2017/09  
 
  2017 Sep;15(9):1382-1389.e1  
  doi: 10.1016/j.cgh.2017.02.029  
 
  Endoscopic and Histologic Healing in Children With Inflammatory Bowel Diseases Treated With Thalidomide  
 
  Lazzerini M, Villanacci V, Pellegrin MC, Martelossi S, Magazzù G, Pellegrino S, Lucanto MC, Barabino A, Calvi A, Arrigo S, Lionetti P, Fontana M, Zuin G, Maggiore G, Bramuzzo M, Maschio M, Salemme M, Manenti S, Lorenzi L, Decorti G, Montico M, Ventura A  
  https://www.ncbi.nlm.nih.gov/pubmed/28286192  
 
 

Abstract

BACKGROUND & AIMS:

Mucosal healing, determined by endoscopic evaluation, is one of the most important prognostic markers for patients with inflammatory bowel diseases. Findings from histologic evaluation, however, could complement findings from endoscopy in assessing mucosal responses to treatment. We analyzed long-term results of children treated with thalidomide to determine the association between clinical response and histology and endoscopy findings.

METHODS:

We collected data from 2 multicenter trials of 70 children with refractory Crohn's disease (CD) or ulcerative colitis (UC) (2-18 years old; ileocolonic or colonic disease) given thalidomide or placebo (NCT00720538). Clinical remission and clinical response at 8 weeks were defined as a pediatric CD activity index scores 10 points or lower and a decrease of at least 50% from baseline, respectively, for patients with CD; and as a pediatric UC activity index score below 10 and a decrease of at least 20 points from baseline, respectively, for patients with UC. Patients with a clinical response to 8 weeks' treatment with thalidomide underwent endoscopic examination with biopsy collection at study weeks 12 and 52. Severity of inflammation in patients with UC was assessed by Mayo score and in patients with CD by 4-grade system. Biopsies were assessed for signs of active inflammation, erosion or ulceration, and crypt abscesses and assigned a histologic score.

RESULTS:

Clinical remission was observed in 42 patients (60.0%) and clinical response in 45 patients (64.2%) at Week 8. At Week 52, a total of 38 patients (54.3%) were still in clinical remission or still had a clinical response; 29 patients (41.4%) had mucosal healing, defined as complete healing of erosions or ulcerations, and 20 patients (27.7%) had histologic healing, defined as complete absence of markers of inflammation. Of patients with clinical remission or clinical response, 75.3% also had mucosal healing and 52.6% also had histologic healing. The probability of achieving mucosal healing decreased significantly with increasing values of erythrocyte sedimentation rate (adjusted odds ratio, 0.96; 95% CI, 0.93-0.98; P = .006).

CONCLUSIONS:

In a long-term analysis of data from 2 clinical trials of pediatric patients with CD or UC, 52 weeks' treatment with thalidomide led to clinical remission in 54.3% of patients with ileocolonic or colonic disease; of these patients, 75.3% had mucosal healing and 52.6% also had histologic healing. Further studies are needed to determine how thalidomide therapy affects long-term progression of inflammatory bowel diseases. (ClinicalTrials.gov number NCT00720538).

 

 
Question posée
 
Le thalidomide est-il efficace au cours des MICI pédiatriques ?
 
Question posée
 
Dans ce travail regroupant deux essais dans la maladie de Crohn et la RCH, le thalidomide était efficace à la fois dans l’obtention d’une rémission clinique à S8 et S52 (1 patient sur 2) et plus de 4/10 avaient une cicatrisation muqueuse.
 
Commentaires

Le thalidomide a également montré son efficacité dans la maladie de Crohn réfractaire de l’adulte avec cependant des effets secondaires notables.

 
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