Anti-TNF[alpha] Treatment in Children and Adolescents With Combined Inflammatory Bowel Disease and Autoimmune Liver Disease.

Objectives: Inflammatory bowel disease (IBD) and autoimmune liver disease (AILD) are closely associated, the former often dictating progression of the latter. Antibodies to tumor necrosis factor alpha (anti- TNF[alpha]) are effective in the management of IBD, but may cause liver injury. Methods: Retrospective review of medical records of patients with juvenile AILD who received anti-TNF[alpha] for IBD to evaluate the safety and efficacy of anti-TNF[alpha]. Results: Eleven patients (6 males), aged 9-15y (median 13y) were identified. 10 had ulcerative colitis (UC) and 1 Crohn's disease; 2 had autoimmune hepatitis type 1 (AIH-1) and 9 autoimmune hepatitis-sclerosing cholangitis variant. All patients were started on infliximab (5 mg/kg) and 2 required dose increase (10 mg/kg); 3/11 switched to adalimumab due to allergic reaction or non-response. 3 received adalimumab after losing response or developing antibodies to IFX. Liver function tests (LFTs) improved in 5, 1 continued to have stably abnormal LFTs and 2 maintained normal LFTs. Patients on adalimumab showed stable or improved liver function compared to pre-treatment status. 6/8 treated with a full course of infliximab maintained clinical remission of IBD for 6m-2.5y; of the 6 patients treated with adalimumab, one sustained IBD clinical remission for 24 months, 2 achieved remission only after tacrolimus addition and 3 did not respond. Conclusions: IBD in patients with AILD can be aggressive, requiring escalation to anti-TNF[alpha] or switching to other biologics. In this series, anti-TNF[alpha] did not impair liver function and improved gut disease in most of the patients, indicating that it can be beneficial and safe. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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