Journal of Pediatric Gastroenterology and Nutrition

Original Articles: Gastroenterology: Inflammatory Bowel Disease

Oral Tacrolimus in Steroid Refractory and Dependent Pediatric Ulcerative Colitis—A Systematic Review and Meta-Analysis

Corresponding Author

Rishi Bolia MD, DM, FRACP

[email protected]

Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children’s Hospital, Brisbane, Australia

Address correspondence and reprint requests to Rishi Bolia, MD, DM, FRACP, Department of Gastroenterology, Hepatology and Liver Transplant, Children’s Health Queensland Hospital and Health Service, Level 7d, Surgical Directorate, Queensland Children’s Hospital, South Brisbane, Queensland 4101, Australia (e-mail: [email protected]).Search for more papers by this author

Akhil Goel MD,

Akhil Goel MD

Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India

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Pooja Semwal MD,

Pooja Semwal MD

Division of Paediatric Gastroenterology, Department of Paediatrics, All India Institute of Medical Sciences, Rishikesh, India

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Anshu Srivastava MD, DM,

Anshu Srivastava MD, DM

Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

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Rishi Bolia MD, DM, FRACP,

Corresponding Author

Rishi Bolia MD, DM, FRACP

[email protected]

Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children’s Hospital, Brisbane, Australia

Akhil Goel MD,

Akhil Goel MD

Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India

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Pooja Semwal MD,

Pooja Semwal MD

Division of Paediatric Gastroenterology, Department of Paediatrics, All India Institute of Medical Sciences, Rishikesh, India

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Anshu Srivastava MD, DM,

Anshu Srivastava MD, DM

Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

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First published: 12 May 2023

https://doi.org/10.1097/MPG.0000000000003827

Citations: 3

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The authors report no conflicts of interest.

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Abstract

Background:

There are limited treatment options for children with steroid-refractory or dependent ulcerative colitis (UC). A few observational studies suggest efficacy of oral tacrolimus. We performed a systematic review and meta-analysis to assess the efficacy of tacrolimus in pediatric UC.

Methods:

PubMed and Scopus were searched for publications related to the use of oral tacrolimus in pediatric UC. Data regarding the clinical response and colectomy-free survival were extracted from studies that met the selection criteria.

Results:

The search strategy yielded 492 articles of which 7 studies were included in the final review. They included 166 children (111 steroid-refractory, 52 steroid-dependent, 3 no steroids). Majority of cases (150/166 [90%]) were naïve to biologics. An initial response to tacrolimus therapy was seen in 84% (95% CI: 73%–93%) (n = 7 studies). No difference was observed between children with high (>10 ng/mL) or low tacrolimus levels (127/150 [85%] vs 12/16 [75%], P = 0.3). No difference in initial response between the children who were steroid refractory or dependent (92/111 [83%] vs 46/52 [88%], P = 0.36). The response in the biologic-exposed group (n = 10) was 70%. At 1-year follow-up, 15.2% (95% CI: 7%–21%) (n = 2 studies, 85 patients) had a sustained response on only tacrolimus. The pooled frequency of 1-year colectomy-free survival in children treated with initial oral tacrolimus was 64% (95% CI: 53%–75%). Twelve (7.2%) patients required cessation of therapy because of side effects.

Conclusion:

Tacrolimus has a high initial response in biologic naïve UC children. It can be effectively used as a bridge to other therapies with a 1-year colectomy-free survival of 64%.

Graphical Abstract

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Volume77, Issue2

August 2023

Pages 228-234