Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2017; 23(43): 7727-7734
Published online Nov 21, 2017. doi: 10.3748/wjg.v23.i43.7727
Efficacy of thalidomide therapy in pediatric Crohn’s disease with evidence of tuberculosis
Lin Wang, Yan Hong, Jie Wu, Ying-Kit Leung, Ying Huang
Lin Wang, Yan Hong, Jie Wu, Ying-Kit Leung, Ying Huang, Department of Gastroenterology, Pediatric Inflammatory Bowel Disease Research Center, Children’s Hospital of Fudan University, Shanghai 201102, China
Yan Hong, Department of Pediatrics, Taizhou Women’s and Children’s Hospital of Wenzhou Medical University, Taizhou 318000, Zhejiang Province, China
Author contributions: Wang L, Hong Y and Wu J collected the data; Wang L analyzed the data and drafted the manuscript; Leung YK and Huang Y designed and supervised this study; all authors approved the final version to be published.
Supported by Medical Science and Technology Planning Project of Zhejiang Province, China, No. 2015KYB430 (to Hong Y).
Institutional review board statement: The study was approved by the ethics committee of Children’s Hospital of Fudan University, Shanghai, China.
Informed consent statement: All the patients and/or their legal guardians provided written consent forms for the study.
Conflict-of-interest statement: All the authors listed here declare no conflicts of interest related to this study.
Data sharing statement: The dataset is available from the corresponding author at yhuang815@163.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ying Huang, MD, PhD, Department of Gastroenterology, Pediatric Inflammatory Bowel Disease Research Center, Children’s Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai 201102, China. yhuang815@163.com
Telephone: +86-21-64931727 Fax: +86-21-64931901
Received: July 26, 2017
Peer-review started: July 26, 2017
First decision: August 10, 2017
Revised: August 28, 2017
Accepted: September 13, 2017
Article in press: September 13, 2017
Published online: November 21, 2017
Abstract
AIM

To evaluate the efficacy of thalidomide for treating troublesome cases of pediatric Crohn’s disease (CD) with tuberculosis infection.

METHODS

A retrospective study of clinical outcome among children treated with thalidomide was conducted. All patients had evidence of tuberculosis infection with a failure of anti-tuberculosis treatment for more than one year, and were subsequently diagnosed with CD. All the patients received thalidomide treatment with a starting dose of 1.2-2.5 mg/kg per day. Remission was defined as pediatric CD activity index less than or equal to 10.

RESULTS

Ten patients with CD were treated with thalidomide at an average age of 7.2 years and followed up for a median of 22.2 mo. Clinical remission rate was 60% after 9-12 mo of thalidomide treatment. One patient with no response had an interleukin-10 receptor alpha gene mutation. Erythrocyte sedimentation rate, C-reactive protein and platelet count showed a dramatic decrease; hemoglobin level and weight improved significantly after thalidomide treatment when compared with the baseline values.

CONCLUSION

Thalidomide is an effective and safe drug for remission of CD in pediatric patients who have been treated for tuberculosis.

Keywords: Inflammatory bowel disease, Intestinal tuberculosis, Anti- tubercular treatment, Thalidomide, Children

Core tip: Therapies for Crohn’s disease (CD) and intestinal tuberculosis are totally different, and anti-TNF alpha treatment may increase the risk of tuberculosis reactivation. That makes it still tough to treat patients with severe CD with concomitant tuberculosis, especially in high tuberculosis prevalence areas. In the current study, all patients had evidence of tuberculosis infection and diagnosed with CD. Thalidomide yielded a positive result for those special cases, and it could be an alternative drug after treatment of tuberculosis is completed.