Anti-TNF Alpha Therapy and Orofacial Crohnʼs Disease in Pediatrics
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".