Anti-TNF Alpha Therapy and Orofacial Crohnʼs Disease in Pediatrics
Notice bibliographique
Résumé
Orofacial granulomatosis (OFG) is a very rare and disabling manifestation of Crohn's disease (CD). Remission of orofacial Crohn's disease (OCD) is difficult to obtain. The aim of the study was to evaluate the efficacy of infliximab and adalimumab in pediatric patients suffering from OCD. 4 patients (3 boys) with OCD were treated with anti-TNF-α therapy between 2000 and 2012. Clinical data were retrospectively extracted from the medical charts to determine outcome and adverse effects of therapy. Case 1: a 16 year old boy was diagnosed with OFG at the age of 11. Subsequently, he presented with colitis and perianal CD. He responded very well to corticosteroids but failed therapy to 6 mercaptopurine (6MP) and methotrexate. Infliximab (IFX) induced a good clinical response but he developed a serum sickness (polyarthritis) and was switched to adalimumab (ADA) with excellent response. Case 2: a fifteen year old boy presented with severe perianal CD at 12 years of age and was started on IFX at diagnosis. He developed OFG on IFX, which responded very well to corticosteroids. Transient improvement of both OFG and perianal disease was noted by decreasing the interval of administration of IFX. Because of loss of response to IFX and positive ATI (antibody to IFX), he was switched to ADA with an excellent clinical response. Case 3: a 14 year old boy was diagnosed with severe Crohn's colitis and failure to thrive at 10 years of age. On 6MP he developed severe perineal abscess and was switched to IFX. He responded well to IFX but had an allergic reaction, thus was switched to ADA. On ADA, he developed OFG although his digestive symptoms were well controlled. Subsequent local corticosteroid injection in his lips successfully controlled the OFG. Case 4: a 19 year old girl was diagnosed with CD at 3 years of age. She presented with severe OFG, perianal and genital involvement. She received episodic infusions of IFX with only transient improvement and unfortunately her response to ADA was not sustained thus she underwent left sided colectomy with proctectomy then right colectomy with ileostomy, after which her OFG appeared improved on ADA. All 4 patients with OCD had a severe perianal disease and variable colonic involvement. Two patients presented with OFG whereas the other two developed OFG during the course of their disease on biologics. The three boys presented adverse effects to IFX (serum sickness, allergic reaction, loss of response with positive ATI): both OFG and perianal disease responded very well to ADA in 2 patients, including the patient in whom OFG occurred on IFX; in the third patient, perianal disease and colitis were quiescent on ADA but OFG only responded to local corticosteroid injection. Case #4 had the worst clinical course. She improved after completion of her colectomy and her OFG is now well controlled on ADA.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».