Efficacy of adalimumab as second-line therapy in a pediatric cohort of crohn’s disease patients who failed infliximab therapy: The Italian society of pediatric gastroenterology, hepatology, and nutrition experience

Background: Adalimumab (Ada) treatment is an available option for pediatric Crohn’s disease (CD) and the published experience as rescue therapy is limited. Objectives: We investigated Ada efficacy in a retrospective, pediatric CD cohort who had failed previous infliximab treatment, with a minimum follow-up of 6 months. Methods: In this multicenter study, data on demographics, clinical activity, growth, laboratory values (CRP) and adverse events were collected from CD patients during follow-up. Clinical remission (CR) and response were defined with Pediatric CD Activity Index (PCDAI) score ≤10 and a decrease in PCDAI score of ≥12.5 from baseline, respectively. Results: A total of 44 patients were consecutively recruited (mean age 14.8 years): 34 of 44 (77%) had active disease (mean PCDAI score 24.5) at the time of Ada administration, with a mean disease duration of 3.4 (range 0.3–11.2) years. At 6, 12, and 18 months, out of the total of the enrolled population, CR rates were 55%, 78%, and 52%, respectively, with a significant decrease in PCDAI scores (P<0.01) and mean CRP values (mean CRP 5.7 and 2.4 mL/dL, respectively; P<0.01) at the end of follow-up. Steroid-free remission rates, considered as the total number of patients in CR who were not using steroids at the end of this study, were 93%, 95%, and 96% in 44 patients at 6, 12, and 18 months, respectively. No significant differences in growth parameters were detected. In univariate analysis of variables related to Ada efficacy, we found that only a disease duration >2 years was negatively correlated with final PCDAI score (P<0.01). Two serious adverse events were recorded: 1 meningitis and 1 medulloblastoma. Conclusion: Our data confirm Ada efficacy in pediatric patients as second-line biological therapy after infliximab failure. Longer-term prospective data are warranted to define general effectiveness and safety in pediatric CD patients

A trophic model of the benthopelagic fauna distributed in the Santa Maria di Leuca cold-water coral province (Mediterranean Sea)

The benthopelagic fauna distributed in and around the Santa Maria di Leuca (SML) cold-water coral (CWC) province (Northern Ionian Sea–Central Mediterranean Sea) was analyzed through the development of a mass-balanced ecosystem model. A total of nine balanced simulations were provided taking into account the biomass data collected during several experimental bottom trawl surveys carried out from 2005 to 2010 in a depth range between 101 and 541 m. A total of 100 species were included in the analysis corresponding to 15 cephalopods, 25 crustaceans, 7 chondrichthyes and 54 osteichthyes. Simulations were developed maintaining the species-level detail. The total system throughput estimated in the SML CWC province trophic web resulted mainly due to consumption and about 80% of it was maintained by species with trophic level between 2 and 4. Results highlighted important features in terms of the structure and functioning of the system, such as the high level of activity maintained by intermediate trophic levels and the important role of top-down control in the faunal assemblage due to both vertebrate and invertebrate species

Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and Rural Africa

peer reviewe

The use of ciclosporin in paediatric inflammatory bowel disease: an Italian experience

Aim: To asses the efficacy and safety of ciclosporin in a paediatric population with inflammatory bowel disease. Patients and methods: Twenty-three Italian children treated with ciclosporin were studied retrospectively. The indications for treatment were severe unresponsive colitis, chronic active colitis or severe fistulizing Crohn's disease. The treatment duration, follow-up and causes of drug discontinuation were assessed. Results: Sixteen patients were treated intravenously for a mean time of 10 +/- 7 days (1-24 days) and 19 orally for a mean time of 133 days (17-660 days). The mean follow-up of all patients was 13.2 months. Ciclosporin was totally ineffective, being discontinued for surgery, in nine of 23 patients (39%); it was discontinued for partial response in three patients (13%). During treatment, clinical remission was achieved in eight children (35%) and maintained after drug withdrawal in four (17%). In severe unresponsive colitis, urgent colectomy was avoided in 12 (85%) of 14 patients who tolerated the drug. Side-effects appeared in six of 23 patients (26%), and three (13%) required ciclosporin to be discontinued due to neurotoxicity. Conclusions: Ciclosporin shows disappointing long-term results in the treatment of refractory inflammatory bowel disease, but can play an important role in preventing urgent surgery in unresponsive severe colitis. Severe side-effects can occur