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Erschienen in: Monatsschrift Kinderheilkunde 8/2010

01.08.2010 | Leitthema

Therapie chronisch-entzündlicher Darmerkrankungen (CED)

Einsatz von Biologika zur CED-Behandlung bei Kindern und Jugendlichen

verfasst von: Prof. Dr. M. Radke

Erschienen in: Monatsschrift Kinderheilkunde | Ausgabe 8/2010

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Zusammenfassung

Biologika, insbesondere TNFα-Blocker (TNF: Tumornekrosefaktor), haben die Therapie chronisch-entzündlicher Darmerkrankungen optimiert. Infliximab ist als bisher einziger TNFα-Blocker für Kinder mit moderatem bzw. schwerem Morbus Crohn zugelassen. Studiendaten ergaben bei ihnen einen Steroid sparenden und das Wachstum optimierenden Effekt. Bei Versagen einer Standardtherapie sowie bei extraintestinalem Befall und Fisteln ist Infliximab indiziert und wird zunehmend primär oder früh im Therapiekonzept eingesetzt. Bei Kindern mit schwerer Colitis ulcerosa ist es trotz fehlender Zulassung eine mindestens gleichwertige Alternative zu bisherigen Immunsuppressiva. Bei Wirkungsverlust von Infliximab kann Adalimumab trotz fehlender Zulassung als Therapieversuch angewendet werden. Dies gilt sowohl für den Morbus Crohn als auch für die Colitis ulcerosa. In jedem Fall sind Eltern und Patienten entsprechend aufzuklären und über kurz- und langfristige Sicherheitsaspekte der Biologika vollständig zu informieren.
Literatur
1.
Zurück zum Zitat Beaugerie L, Brousse N, Bouvier AM et al (CESAME Study Group) (2009) Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet 374:1617–1625CrossRefPubMed Beaugerie L, Brousse N, Bouvier AM et al (CESAME Study Group) (2009) Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet 374:1617–1625CrossRefPubMed
2.
Zurück zum Zitat Borelli O, Bascietto C, Viola F (2004) Infliximab heals intestinal inflammatory lesions and restores growth in children with Crohn’s disease. Dig Liver Dis 36:342–347CrossRef Borelli O, Bascietto C, Viola F (2004) Infliximab heals intestinal inflammatory lesions and restores growth in children with Crohn’s disease. Dig Liver Dis 36:342–347CrossRef
3.
Zurück zum Zitat Colombel JF, Sandborn WJ, Reinisch W et al (2010) Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med 362:1383–1395CrossRefPubMed Colombel JF, Sandborn WJ, Reinisch W et al (2010) Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med 362:1383–1395CrossRefPubMed
4.
Zurück zum Zitat Crandall W, Hyams J, Kugathasan S et al (2009) Infliximab therapy in children with concurrent perianal Crohn disease: observations from REACH. J Pediatr Gastroenterol Nutr 49:183–190CrossRefPubMed Crandall W, Hyams J, Kugathasan S et al (2009) Infliximab therapy in children with concurrent perianal Crohn disease: observations from REACH. J Pediatr Gastroenterol Nutr 49:183–190CrossRefPubMed
5.
Zurück zum Zitat Cucchiara S, Latiano A, Palmieri O et al (2007) Polymorphisms of tumor necrosis factor-alpha but not MDR1 influence response to medical therapy in pediatric-onset inflammatory bowel disease. J Pediatr Gastroenterol Nutr 44:171–179CrossRefPubMed Cucchiara S, Latiano A, Palmieri O et al (2007) Polymorphisms of tumor necrosis factor-alpha but not MDR1 influence response to medical therapy in pediatric-onset inflammatory bowel disease. J Pediatr Gastroenterol Nutr 44:171–179CrossRefPubMed
6.
Zurück zum Zitat De Zoten E, Mamula P (2008) What are the guidelines for using biologics in pediatric patients? Inflamm Bowel Dis 14:S259–S261CrossRef De Zoten E, Mamula P (2008) What are the guidelines for using biologics in pediatric patients? Inflamm Bowel Dis 14:S259–S261CrossRef
7.
Zurück zum Zitat Eidelwein AP, Cuffari C, Abadom V, Oliva-Hemker M (2005) Infliximab efficacy in pediatric ulcerative colitis. Inflamm Bowel Dis 11:213–218CrossRefPubMed Eidelwein AP, Cuffari C, Abadom V, Oliva-Hemker M (2005) Infliximab efficacy in pediatric ulcerative colitis. Inflamm Bowel Dis 11:213–218CrossRefPubMed
8.
Zurück zum Zitat Escher JC, Taminiau JAJM, Nieuwenhuis EES et al (2003) Treatment of inflammatory bowel disease in childhood: best available evidence. Inflamm Bowel Dis 9:34–58CrossRefPubMed Escher JC, Taminiau JAJM, Nieuwenhuis EES et al (2003) Treatment of inflammatory bowel disease in childhood: best available evidence. Inflamm Bowel Dis 9:34–58CrossRefPubMed
9.
Zurück zum Zitat Feldman TL, Rosh JR (2009) Infliximab in the treatment of pediatric Crohn’s disease. Therapy 6:15–22CrossRef Feldman TL, Rosh JR (2009) Infliximab in the treatment of pediatric Crohn’s disease. Therapy 6:15–22CrossRef
10.
Zurück zum Zitat Grossman AB, Mamula P (2008) What is the optimal management approach for pediatric patients with severe ulcerative colitis? Nat Clin Pract Gastroenterol Hepatol 5:541–543CrossRef Grossman AB, Mamula P (2008) What is the optimal management approach for pediatric patients with severe ulcerative colitis? Nat Clin Pract Gastroenterol Hepatol 5:541–543CrossRef
11.
Zurück zum Zitat Hanauer SB, Wager CL, Bala M (2004) Incidence and importance of antibody response to infliximab after maintenance or episodic treatment in Crohn’s disease. Clin Gastroenterol Hepatol 2:542–543CrossRefPubMed Hanauer SB, Wager CL, Bala M (2004) Incidence and importance of antibody response to infliximab after maintenance or episodic treatment in Crohn’s disease. Clin Gastroenterol Hepatol 2:542–543CrossRefPubMed
12.
Zurück zum Zitat Hyams J, Crandall W, Kugathasan S et al (2007) Induction and maintenance infliximab therapy for the treatment of moderate-to-severe Crohn’s disease in children. Gastroenterology 132:863–873CrossRefPubMed Hyams J, Crandall W, Kugathasan S et al (2007) Induction and maintenance infliximab therapy for the treatment of moderate-to-severe Crohn’s disease in children. Gastroenterology 132:863–873CrossRefPubMed
13.
Zurück zum Zitat Hyams J, Lerer T, Griffiths A et al (2009) Long-term outcome of maintenance infliximab therapy in children with Crohn’s disease. Inflamm Bowel Dis 15:816–822CrossRefPubMed Hyams J, Lerer T, Griffiths A et al (2009) Long-term outcome of maintenance infliximab therapy in children with Crohn’s disease. Inflamm Bowel Dis 15:816–822CrossRefPubMed
14.
Zurück zum Zitat IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (2005) Inflammatory bowel disease in children and adolescents: recommendations for diagnosis – the Porto criteria. J Pediatr Gastroenterol Nutr 41:1–7CrossRef IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (2005) Inflammatory bowel disease in children and adolescents: recommendations for diagnosis – the Porto criteria. J Pediatr Gastroenterol Nutr 41:1–7CrossRef
15.
Zurück zum Zitat Jacobstein DA, Markowitz JE, Kirschner BS (2005) Premedication and infusion reactions with infliximab: results from a pediatric inflammatory bowel disease consortium. Inflamm Bowel Dis 11:442–446CrossRefPubMed Jacobstein DA, Markowitz JE, Kirschner BS (2005) Premedication and infusion reactions with infliximab: results from a pediatric inflammatory bowel disease consortium. Inflamm Bowel Dis 11:442–446CrossRefPubMed
16.
Zurück zum Zitat Jarnerot G (2005) Infliximab as rescue therapy in severe to moderate ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 128:1805–1811CrossRefPubMed Jarnerot G (2005) Infliximab as rescue therapy in severe to moderate ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 128:1805–1811CrossRefPubMed
17.
Zurück zum Zitat Klotz U, Teml A, Schwab M (2007) Clinical pharmacokinetics and use of infliximab. Clin Pharmacokinet 46:645–660CrossRefPubMed Klotz U, Teml A, Schwab M (2007) Clinical pharmacokinetics and use of infliximab. Clin Pharmacokinet 46:645–660CrossRefPubMed
18.
Zurück zum Zitat Pfefferkorn M, Burke G, Griffith A et al (2009) Growth abnormalities persist in newly diagnosed children with Crohn disease despite current treatment paradigms. J Pediatr Gastroenterol Nutr 48:168–174CrossRefPubMed Pfefferkorn M, Burke G, Griffith A et al (2009) Growth abnormalities persist in newly diagnosed children with Crohn disease despite current treatment paradigms. J Pediatr Gastroenterol Nutr 48:168–174CrossRefPubMed
19.
Zurück zum Zitat Quaglietta L, Velde A te, Staiano A et al (2007) Functional consequences of NOD2/CARD15 mutations in Crohn disease. J Pediatr Gastroenterol Nutr 44:529–539CrossRefPubMed Quaglietta L, Velde A te, Staiano A et al (2007) Functional consequences of NOD2/CARD15 mutations in Crohn disease. J Pediatr Gastroenterol Nutr 44:529–539CrossRefPubMed
20.
Zurück zum Zitat Rosh JR, Gross T, Mamula P (2007) Hepatosplenic T-cell lymphoma in adolescents and young adults with Crohn’s disease: a cautionary tale? Inflamm Bowel Dis 13:1024–1030CrossRefPubMed Rosh JR, Gross T, Mamula P (2007) Hepatosplenic T-cell lymphoma in adolescents and young adults with Crohn’s disease: a cautionary tale? Inflamm Bowel Dis 13:1024–1030CrossRefPubMed
21.
Zurück zum Zitat Rosh JR, Markowitz J, Goli SR (2008) Retrospective evaluation of the safety and effect of adalimumab therapy (Reseat) in pediatric Crohn’s disease. Gastroenterology 134:A657CrossRef Rosh JR, Markowitz J, Goli SR (2008) Retrospective evaluation of the safety and effect of adalimumab therapy (Reseat) in pediatric Crohn’s disease. Gastroenterology 134:A657CrossRef
22.
Zurück zum Zitat Ruemmele FM, Lachaux A, Cézard J-P et al (2009) Efficacy of infliximab in pediatric Crohn’s disease: a randomized multicenter open-label trial comparing scheduled to on demand maintenance therapy. Inflamm Bowel Dis 15:388–394CrossRefPubMed Ruemmele FM, Lachaux A, Cézard J-P et al (2009) Efficacy of infliximab in pediatric Crohn’s disease: a randomized multicenter open-label trial comparing scheduled to on demand maintenance therapy. Inflamm Bowel Dis 15:388–394CrossRefPubMed
23.
Zurück zum Zitat Rutgeerts P, Feagan BG, Lichtenstein GR (2004) Comparison of scheduled and episodic treatment strategies of infliximab in Crohn’s disease. Gastroenterology 126:402–413CrossRefPubMed Rutgeerts P, Feagan BG, Lichtenstein GR (2004) Comparison of scheduled and episodic treatment strategies of infliximab in Crohn’s disease. Gastroenterology 126:402–413CrossRefPubMed
24.
Zurück zum Zitat Sinitsky DM, Lemberg DA, Leach ST et al (2010) Infliximab improves inflammation and anthropometric measures in pediatric Crohn’s disease. J Gastroenterol Hepatol 25:810–816CrossRefPubMed Sinitsky DM, Lemberg DA, Leach ST et al (2010) Infliximab improves inflammation and anthropometric measures in pediatric Crohn’s disease. J Gastroenterol Hepatol 25:810–816CrossRefPubMed
25.
Zurück zum Zitat Turner D, Walsh CM, Benchimol EI et al (2008) Severe paediatric ulcerative colitis: incidence, outcomes and optimal timing for second-line therapy. Gut 57:331–338CrossRefPubMed Turner D, Walsh CM, Benchimol EI et al (2008) Severe paediatric ulcerative colitis: incidence, outcomes and optimal timing for second-line therapy. Gut 57:331–338CrossRefPubMed
26.
Zurück zum Zitat Veres G (2007) Infliximab therapy in children and adolescents with inflammatory bowel disease. Drugs 67:1703–1723CrossRefPubMed Veres G (2007) Infliximab therapy in children and adolescents with inflammatory bowel disease. Drugs 67:1703–1723CrossRefPubMed
27.
Zurück zum Zitat Vermeire S, Noman M, Assche GV van et al (2007) Effectiveness of concomitant immunosuppressive therapy in suppressing the formation of antibodies to infliximab in Crohn’s disease. Gut 56:1226–1231CrossRefPubMed Vermeire S, Noman M, Assche GV van et al (2007) Effectiveness of concomitant immunosuppressive therapy in suppressing the formation of antibodies to infliximab in Crohn’s disease. Gut 56:1226–1231CrossRefPubMed
28.
Zurück zum Zitat Walters TD, Gilman AR, Griffiths AM (2007) Liniar growth improves during infliximab therapy in children with chronically active severe Crohn’s disease. Inflamm Bowel Dis 13:424–430CrossRefPubMed Walters TD, Gilman AR, Griffiths AM (2007) Liniar growth improves during infliximab therapy in children with chronically active severe Crohn’s disease. Inflamm Bowel Dis 13:424–430CrossRefPubMed
29.
Zurück zum Zitat Wynands J, Belbouab R, Candon S et al (2008) 12-month follow-up after successful infliximab therapy in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 46:293–298CrossRefPubMed Wynands J, Belbouab R, Candon S et al (2008) 12-month follow-up after successful infliximab therapy in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 46:293–298CrossRefPubMed
30.
Zurück zum Zitat Wyneski MJ, Green A, Kay M et al (2008) Safety and efficacy of adalimumab in pediatric patients with Crohn disease. J Pediatr Gastroenterol Nutr 47:19–25CrossRefPubMed Wyneski MJ, Green A, Kay M et al (2008) Safety and efficacy of adalimumab in pediatric patients with Crohn disease. J Pediatr Gastroenterol Nutr 47:19–25CrossRefPubMed
Metadaten
Titel
Therapie chronisch-entzündlicher Darmerkrankungen (CED)
Einsatz von Biologika zur CED-Behandlung bei Kindern und Jugendlichen
verfasst von
Prof. Dr. M. Radke
Publikationsdatum
01.08.2010
Verlag
Springer-Verlag
Erschienen in
Monatsschrift Kinderheilkunde / Ausgabe 8/2010
Print ISSN: 0026-9298
Elektronische ISSN: 1433-0474
DOI
https://doi.org/10.1007/s00112-010-2195-3

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