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PEDIATRIC-ONSET INFLAMMATORY BOWEL DISEASE: FROM PATHOPHYSIOLOGY TO NEW STRATEGIES FOR THERAPY CHOICE AND MONITORING
Full text linkIntroduzione: La terapia con anticorpi monoclonali anti-tumor necrosis factor (TNF) ha portato a una rivoluzione nella terapia delle malattie infiammatorie croniche intestinali (MICI), tuttavia una percentuale non trascurabile di pazienti non risponde alla terapia. Vi sono evidenze in costante aumento che suggeriscono che il fallimento terapeutico può essere dovuto a livelli ematici inadeguati di farmaco e/o alla comparsa di anticorpi anti-farmaco. appearance of anti-infliximab antibodies (AIA). I dati riguardanti il monitoraggio terapeutico dell'infliximab (IFX) nei bambini sono tuttavia ancora incompleti.
Metodi: Abbiamo studiato 49 pazienti pediatrici (età media 14.4) affetti da MICI (Malattia di Crohn 34, rettocolite ulcerosa 15) trattati con IFX. Sono stati raccolti campioni di siero a 6, 14, 22 e 54 settimane di terapia, prima delle infusioni di IFX. I livelli di IFX e di AIA sono stati misurati mediante test ELISA e posti in relazione con l'attività clinica di malattia misurata mediante score clinici (PCDAI/PUCAI)
Risultati: Il 76.3% e il 73.9% dei pazienti ha ottenuto la remissione clinica, definita come uno score clinico 3.11 (p-value = 3.0x10-5, sensitivity 89%, specificity 80%). I valori ematici di AIA sono risultati inversamente correlati con i livelli di IFX (p = 0.00088) e con il rischio di reazioni avverse (p = 0.018).
Conclusioni: La misurazione dei livelli ematici di infliximab pre-infusione alla fine dell'induzione è associata con la probabilità di remissione duratura nei pazienti pediatrici affetti da MICI.Background: Anti-tumor necrosis factor monoclonal antibodies have lead to a revolution in the treatment of inflammatory bowel diseases (IBD), yet a sizable proportion of patients do not respond to therapy. There is increasing evidence suggesting that treatment failure may be associated with inadequate blood drug levels and/or the appearance of anti-infliximab antibodies (AIA). Data regarding therapeutic drug monitoring of infliximab (IFX) in children however are still incomplete.
Methods: We studied 49 pediatric (median age 14.4) IBD patients (Crohn’s disease 34, ulcerative colitis 15) treated with IFX. Serum samples were collected at 6, 14, 22 and 54 weeks, before IFX infusions. IFX and AIA were measured using ELISA assays. Disease activity was determined by PUCAI or PCDAI.
Results: Clinical remission, defined as a clinical score 3.11 (p-value = 3.0x10-5, sensitivity 89%, specificity 80%). AIA concentrations were inversely correlated with IFX concentrations (p-value = 0.00088) and with adverse reactions (p-value = 0.018).
Conclusions: Measurement of IFX trough levels at the end of induction therapy (week 14) is associated with sustained long-term response in pediatric patients with IBD
Piomiosite 2016: ancora una sfida per il pediatra
No full textPyomyositis is a subacute, deep bacterial infection of skeletal muscles. Originally described in tropical areas, mainly in malnourished and immunocompromised subjects (“tropical pyomyositis”), it has been subsequently reported with an increasing frequency also in temperate climates. Larger muscle groups located in the pelvic girdle and in the lower extremities (including the thigh, calf and gluteal muscles) are most commonly affected, but any muscle group can be involved. S. aureus is the most common causative agent, being responsible for up to 90% of tropical cases and up to 75% of cases in temperate areas. Local trauma as a predisposing factor is reported in up to 39% of cases. There are no specific laboratory tests for pyomyositis. MRI is the gold standard for the diagnosis.
Treatment of pyomyositis largely depends on the stage of the disease. Prompt intravenous antibiotic therapy targeted on Staphylococcus aureus is generally effective for early infections. Both antibiotic therapy and drainage are necessary in more advanced stages. The paper reports one of muscle gluteus maximus involvement, reviews the literature and describes the experience with pyomyositis at Institute for Maternal and Child Health IRCCS “Burlo Garofolo” (Trieste, Italy) over the past ten years
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