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Costaguta GA, Girard C, Groleau V, Grzywacz K, Dirks MH, Deslandres C. The Role of Tofacitinib in the Treatment of Acute Severe Colitis in Children. J Can Assoc Gastroenterol 2024; 7:196-203. [PMID: 38596797 PMCID: PMC10999772 DOI: 10.1093/jcag/gwad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Objectives Acute severe colitis (ASC) occurs in up to 15 percent of children with ulcerative colitis, with a high index of morbidity and mortality. Treatment includes high-dose steroids, infliximab, and salvage therapies. Unfortunately, up to 20 percent of patients may need an urgent colectomy due to treatment failure. We report our experience using tofacitinib for the treatment of six patients. Methods A retrospective review of our medical electronic records was conducted. We included every patient with ASC and treatment failure, in whom tofacitinib was used as a salvage therapy. Response, complications, and disease course were noted. Results Six patients were included with Pediatric Ulcerative Colitis Activity Index (PUCAI) scores ranging from 65 to 85 on admission, and 35 to 85 before tofacitinib was started (P 0.07). Median response time was 72 h. A median decrease of 40 points in PUCAI was noted (P 0.00001). Mean length of stay was 18 days with discharge 9 days after tofacitinib introduction. Haemoglobin, albumin, fecal calprotectin, and CRP improved after tofacitinib (P 0.02, P 0.02, P 0.025, and P 0.01, respectively). The mean follow-up was 8.5 months, four patients achieved complete remission and only one had a recrudescence of symptoms (P 0.01). One patient had a systemic Epstein-Barr virus infection prior to tofacitinib therapy, which resolved with rituximab treatment. No other complications were noted. Conclusions Tofacitinib response is rapid and impressive in children suffering from ASC, and the safety profile appears comparable to or better than other available treatments. In the future, tofacitinib should be integrated into pediatric protocols.
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Affiliation(s)
- Guillermo Alejandro Costaguta
- Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, 3175 Chem de la Côte-Sainte-Catherine, H3T 1C5, Montreal, Quebec, Canada
| | - Chloé Girard
- Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, 3175 Chem de la Côte-Sainte-Catherine, H3T 1C5, Montreal, Quebec, Canada
| | - Véronique Groleau
- Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, 3175 Chem de la Côte-Sainte-Catherine, H3T 1C5, Montreal, Quebec, Canada
- Department of Pediatrics of the Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada
| | - Kelly Grzywacz
- Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, 3175 Chem de la Côte-Sainte-Catherine, H3T 1C5, Montreal, Quebec, Canada
- Department of Pediatrics of the Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada
| | - Martha Heather Dirks
- Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, 3175 Chem de la Côte-Sainte-Catherine, H3T 1C5, Montreal, Quebec, Canada
- Department of Pediatrics of the Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada
| | - Colette Deslandres
- Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, 3175 Chem de la Côte-Sainte-Catherine, H3T 1C5, Montreal, Quebec, Canada
- Department of Pediatrics of the Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada
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Girard C, Dirks M, Deslandres C. Tofacitinib to Treat Severe Acute Refractory Colitis in a Teenager: Case Report and Review of the Literature. JPGN REPORTS 2022; 3:e241. [PMID: 37168636 PMCID: PMC10158282 DOI: 10.1097/pg9.0000000000000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/18/2022] [Indexed: 05/13/2023]
Abstract
Acute severe colitis (ASC) may occur within 3 months of ulcerative colitis diagnosis in 9%-15% of children and the rate of colectomy is up to 40%-50% within 5 years after an ASC. The aim of this publication is to present recent and relevant data on the success of medical treatment with tofacitinib in ASC. Methods We report a challenging case of a teenage boy with ASC at diagnosis and conduct a discussion after a review of the literature regarding the use of tofacitinib in inflammatory bowel disease, especially in pediatric patients and in ASC. Results The patient was hospitalized for 10 weeks and was refractory to conventional therapies: intravenous corticosteroids, infliximab, methotrexate, and vedolizumab. He received 7 blood transfusions and also presented with a severe malnutrition requiring a total parenteral nutrition. Tofacitinib was considered as a medical last resort before colectomy and was started at week 8. Thirteen days after starting tofacitinib, he was asymptomatic and was discharged on tofacitinib as sole treatment. By week 9 of tofacitinib, a colonoscopy showed both endoscopic and histological remission. He has remained in clinical remission at 6-month follow-up. Conclusions Tofacitinib may be an alternative medical treatment to avoid colectomy in ASC. It is a small molecule with a rapid onset and few severe adverse events. It has been used for ASC in adult patients, allowing to avoid colectomy in more than 60%. To our knowledge, this is one of the few pediatric patients with refractory ASC at initial diagnosis who responded to tofacitinib.
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Affiliation(s)
- Chloé Girard
- From the Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Martha Dirks
- From the Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Colette Deslandres
- From the Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada
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Cossio ML, Genois A, Jantchou P, Hatami A, Deslandres C, McCuaig C. Skin Manifestations in Pediatric Patients Treated With a TNF-Alpha Inhibitor for Inflammatory Bowel Disease: A Retrospective Study [Formula: see text]. J Cutan Med Surg 2020; 24:333-339. [PMID: 32527153 DOI: 10.1177/1203475420917387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tumor necrosis factor (TNF) alpha inhibitors (anti-TNF) are effective in the treatment of inflammatory bowel disease (IBD) as well as psoriasis. Their increasing use has raised the identification of cutaneous side effects (CSEs). Evidence in children is limited. OBJECTIVES The objective of this study is to describe CSEs of anti-TNF treatment in a pediatric population with IBD. METHODS This is a retrospective single-center study of children with IBD under anti-TNF treatment between 2013 and 2016. A total of 40 patients with CSEs related to anti-TNF were referred to our pediatric dermatology clinic. A control group was randomly selected from patients receiving anti-TNF for IBD, who were referred to the dermatology clinic for other conditions unrelated to anti-TNF. RESULTS Of 343 patients with IBD, 40 (11.3%) presented CSEs potentially related to the treatment. No differences in sex, age, and underlying disease were found between those with and without CSEs. The most frequent CSEs were psoriasiform eruptions (41%) which were more exudative than usual, located especially in skin folds and on the scalp; skin infections (20%); and eczematous eruptions (10%). Only 5% of patients changed or discontinued the current anti-TNF because of CSEs. CONCLUSION This is one of the largest pediatric cohorts of IBD patients with CSEs. Psoriasiform eruptions were the most common CSEs, with predilection for skin folds and scalp, and frequent superimposed bacterial infection. Topical and/or systemic antibiotics were required in addition to topical corticosteroids in 25% of patients. The rate of discontinuation of anti-TNF therapy due to CSEs was low.
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Affiliation(s)
- María-Laura Cossio
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, QC, Canada
- 28033Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Annie Genois
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, QC, Canada
| | - Prévost Jantchou
- 25461Division of Gastroenterology, CHU Sainte-Justine, University of Montreal, QC, Canada
| | - Afshin Hatami
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, QC, Canada
| | - Colette Deslandres
- 25461Division of Gastroenterology, CHU Sainte-Justine, University of Montreal, QC, Canada
| | - Catherine McCuaig
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, QC, Canada
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