Evaluation of the efficacy of different treatment regimens for ulcerative colitis in children
Authors:   National Medical Research Center for Children’s Health, Moscow, Russian Federation, Vinokurova A.V. , Potapov A.S. ,   National Medical Research Center for Children’s Health, Moscow, Russian Federation,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Lokhmatov M.M. ,   National Medical Research Center for Children’s Health, Moscow, Russian Federation,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Khazykova D.V. ,   National Medical Research Center for Children’s Health, Moscow, Russian Federation, Semikina E.L. ,   National Medical Research Center for Children’s Health, Moscow, Russian Federation,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Budkina T.N. ,   National Medical Research Center for Children’s Health, Moscow, Russian Federation, Kulikov K.A. ,   National Medical Research Center for Children’s Health, Moscow, Russian Federation, Prokhorenkova M.O. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Fisenko A.P. ,   National Medical Research Center for Children’s Health, Moscow, Russian Federation
Published: April 2024

Objective. To evaluate the efficacy of therapy for ulcerative colitis in children using current diagnostic methods. Patients and methods. The efficacy of different treatment regimens was evaluated in 104 patients aged 7 years to 17 years 11 months with ulcerative colitis. All patients were divided into five groups: group I received 5-aminosalicylic acid (5-ASA), group II – 5-ASA, hormonal and cytostatic therapy, group III – adalimumab, group IV – infliximab, group V – vedolizumab. Clinical, endoscopic, and morphological activity indices were assessed, as well as laboratory parameters, intestinal wall thickness and blood flow by ultrasound at baseline and after 6 months of therapy. Results. The PUCAI clinical index decreased in group IV (p = 0.007) and group V (p = 0.005), the UCEIS endoscopic index decreased in group II (p < 0.001) and group V (p = 0.005), and fecal calprotectin levels decreased in group IV (p = 0.026) and group V (p = 0.013). The levels of albumin altered only in group II (p < 0.001), hemoglobin – in group II (p = 0.037) and group V (p = 0.017), C-reactive protein – in group II (p = 0.035), and white blood cells – in group IV (p = 0.011). No statistically significant changes in ESR were found in any of the study groups. Transabdominal ultrasound revealed a statistically significant decrease in intestinal wall thickness and blood flow in group V (p = 0.028, p = 0.003, respectively). Endoscopic ultrasound revealed a decrease in the wall thickness of the sigmoid colon and rectum in group II (p = 0.032), group IV (p = 0.013), and group V (p = 0.008), and the wall thickness of the sigmoid colon decreased only in group V (p = 0.003). Endoscopic ultrasound also showed a statistically significant decrease in blood flow in the sigmoid colon and rectum in group IV (p = 0.046) and group V (p = 0.014). Morphological activity according to the Nancy index decreased in group II (p = 0.002), group IV (p = 0.015), and group V (p = 0.007). Conclusion. The most effective and safe treatment regimen for ulcerative colitis in children was shown to be vedolizumab administration, in which a decrease in clinical and laboratory, endoscopic and morphological activity was observed. Key words: ulcerative colitis, biological therapy, vedolizumab, colonoscopy, endoscopic ultrasound, Nancy index