英夫利西单克隆抗体转换阿达木单克隆抗体治疗儿童炎症性肠病的疗效探讨  

Efficacy of switching from infliximab to adalimumab in children with inflammatory bowel disease

作　　者：方优红[1] 罗优优[1] 陈洁[1] Fang Youhong;Luo Youyou;Chen Jie(Department of Gastroenterology,National Clinical Research Center for Child Health,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院消化科、国家儿童健康与疾病临床医学研究中心,杭州310052

出　　处：《中华炎性肠病杂志(中英文)》2024年第6期424-428,共5页Chinese Journal of Inflammatory Bowel Diseases

摘　　要：目的分析儿童炎症性肠病(IBD)英夫利西单克隆抗体(IFX)治疗失败后转换阿达木单克隆抗体(ADA)治疗的疗效。方法回顾性纳入2019年1月至2023年5月浙江大学医学院附属儿童医院IFX治疗失败后转换为ADA治疗的IBD患儿临床资料。收集ADA治疗基线、诱导缓解治疗3个月及治疗12个月的实验室指标、疾病活动度等临床指标。结果共纳入47例IBD患儿,其中克罗恩病36例,溃疡性结肠炎4例,炎症性肠病未分型7例。男性28例,女性19例。转换ADA治疗的原因包括抗IFX抗体产生且IFX谷浓度低31例(66.0%)、IFX过敏12例(25.5%)、无抗IFX抗体产生但IFX谷浓度低4例(8.5%)。治疗12个月后ADA总留存率为76.6%(36/47)。ADA治疗3个月年龄别体质指数Z评分、年龄别身高Z评分及血清白蛋白水平较基线增加,炎症相关指标超敏C反应蛋白、红细胞沉降率及儿童克罗恩病疾病活动评分下降;治疗12个月与治疗3个月相比,营养相关指标及炎症相关指标稳定。6例患儿(13%)出现注射部位局部疼痛、红肿。2例患儿产生高滴度抗ADA抗体,未发现其他严重不良反应及严重感染。结论IBD患儿使用IFX治疗失败后转换ADA治疗3个月,可改善患儿营养指标、血清白蛋白水平,降低炎症指标及疾病活动指数,无严重不良反应,为临床上儿童IBD的生物制剂转换提供实践依据。ObjectiveTo analyze the efficacy of switching to adalimumab(ADA)treatment in pediatric with inflammatory bowel disease(IBD)after failure of infliximab(IFX)treatment.MethodsClinical data of children with IBD who were treated at the Children's Hospital of Zhejiang University School of Medicine from January 2019 to May 2023 and switched to ADA treatment after IFX treatment failure were retrospectively included.The clinical symptoms,laboratory results,disease activity index of pediatrics,and endoscopic severity scores under colonoscopy were compared between baseline,treatment after 3 months and 12 months.ResultsA total of 47 IBD patients were enrolled,including 36 cases of Crohn's disease,4 cases of ulcerative colitis,and 7 cases of IBD unclassified.There were 28 male and 19 female patients.Among patients who were converted to ADA treatment,31/47(66.0%)had low trough concentration and high anti-IFX antibodies,12/47(25.5%)had allergic reactions to IFX,and 4/47(8.5%)had low IFX trough concentration and no anti-IFX antibody.The overall 12 month retention rate of IBD patients who converted to ADA treatment after IFX treatment was 76.6%(36/47).After 3 months of ADA treatment,compared to the baseline,in body mass index for age,height for age,and serum albumin levels increased,while inflammatory markers such as high sensitivity C reactive protein,erythrocyte sedimentation rate,and pediatric Crohn's disease activity index scores decreased.Compared to 3 months of treatment,nutritional and inflammatory markers after 12 months of treatment were stable.No serious adverse reactions or severe infections were found.Six(13%)patients who had pain and swelling at the injection site.Two patients were detected to have high titers of antibodies.ConclusionsPediatric IBD patients switched to ADA treatment after failure of IFX treatment with ADA for 3 months improves nutrition status and serum albumin levels,while reducing inflammatory markers and disease activity.No serious adverse reactions are found.Application of ADA after failure of IF

关 键 词：炎症性肠病 阿达木单克隆抗体 英夫利西单克隆抗体 疗效 儿童 

分 类 号：R57[医药卫生—消化系统]