Efficacy of infliximab after loss of response of/intolerance to adalimumab in pediatric Crohn's disease: A retrospective multicenter cohort study of the "GETAID pédiatrique".

BACKGROUND: Infliximab (IFX) and adalimumab (ADA) are recommended for induction and maintenance of remission in pediatric Crohn's disease (CD). ADA is now often used in first line due to its efficacy and tolerability, but a loss of response (LOR) can occur over time. The aim was to assess the efficacy of IFX as second line therapy after LOR or intolerance to ADA in pediatric CD patients at 1 year. METHODS: We conducted a retrospective and multicenter study in France among the "GETAID pédiatrique" centers between April 2019 and April 2022. CD patients under 18 years old and treated with IFX after ADA failure or intolerance were included. We collected anthropometric, clinical, and biological data at baseline (start of IFX), at 6 and 12 months. Clinical remission was defined by a Weighted Pediatric CD Activity Index (wPCDAI) score less than 12.5 points. RESULTS: Of the 32 patients included in our study, 27 (84.4%) were still on IFX at 12 months of the switch. Among them, 13 had discontinued ADA because of a LOR, 12 for insufficient response and 2 due to primary nonresponse. At M12, 22 patients were in corticosteroid free clinical remission (68.7%). Under IFX, the wPCDAI decreased over time (47.5 ± 24.1, 16.6 ± 21.2 and 9.7 ± 19.0 at M0, M6 and M12 respectively). The only factor associated with clinical remission at 12 months was absence of perianal disease at the end of the IFX induction. CONCLUSIONS: IFX is effective in maintaining remission at 1 year in pediatric CD patients experiencing a LOR or intolerance with ADA, and IFX could be an interesting therapeutic choice instead of other biologics in this situation.

Outcomes of Blenderized Gastrostomy Feeding in Children at Rouen University Hospital.

Purpose: During the last few years, there has been an observed increase in the demand for blenderized tube feeding (BTF) in the outpatient setting among the caregivers of children suffering from chronic illnesses. This study aimed to assess the clinical and biochemical effect of BTF on children's general health and determine the psychosocial effect of this feeding type on their families. Patients and Methods: This monocenter, retrospective study was conducted at the pediatric department of Rouen Hospital, France, and included ten children receiving a blended diet via enteral feeding tubes. Data were collected from the patients' profiles and by interviewing the caregivers to evaluate the clinical effects of BTF and its psychosocial effects on caregivers. Additionally, patients' medical records were reviewed for their nutritional status by assessing anthropomcetric measurements and biochemical markers recorded during follow-up visits. Results: Ten patients were included (mean age, 6.2 years), and the mean BTF duration was 2.8 years. The patients were fed either homemade or commercial puree. Upper gastrointestinal symptoms such as vomiting improved rapidly after the introduction of blended food in six children (60%), where four experienced complete symptom regression and two showed marked improvement. Similarly, gagging and retching were alleviated in all cases. Diarrhea was alleviated in all cases, whereas constipation improved in three out of four patients. The families were satisfied with using natural BTF; however, caregivers cited the time taken to deliver blended food via syringe as a disadvantage. Conclusion: We observed an improvement in gastrointestinal symptoms after the use of blended feeding by gastrostomy. Additionally, BTF had a positive psychological effect on caregivers.