| Abstract | UVOD: U dječjoj populaciji biološka terapija pokazala je velike uspjehe, no zbog ne tako dugog korištenja nismo upoznati u potpunosti s nuspojavama koje uključuje te posljedicama koje ostavlja na daljnji rast i razvoj djeteta. CILJ: Ispitati učestalost i težinu nuspojava biološke terapije primijenjene u djece oboljele od reumatskih bolesti, odrediti vrijeme koje je proteklo od postavljanja dijagnoze do početka provođenja biološke terapije i ishod nakon primjene biološke terapije.
----- ISPITANICI I METODE: U istraživanje je uključeno 53 djece s dijagnozom reumatskih bolesti koja su liječena biološkom terapijom u Klinici za pedijatriju, Zavodu za imunologiju i reumatologiju, KBC Zagreb, u razdoblju od 2008. godine do 2013. godine. Analizirali smo medicinsku dokumentaciju dotičnih bolesnika.
----- REZULTATI: U vremenskom razdoblju od 2008. do 2013. godine na Zavodu je biološka terapija provedena kod 53 djece. Skupinu čine 21 dječak i 32 djevojčice. Prosječno vrijeme proteklo od postavljanja dijagnoze do početka uvođenja biološke terapije je 3.698 godina (minimalno 28 dana, maksimalno 15 godina). U terapiji su korištena 2 oblika biološke terapije: anticitokinska terapija, anti TNF pripravci (etanrecept 18 djece, adalimumab 22 djece, infliximab 5 djece, ukupno 44 djece), anti IL 6 (tocilizumab, 3 djece) i terapija usmjerena na B limfocite, anti CD 20 (rituximab, 5 djece). Više od jednog biološkog pripravka korišteno je kod 6 djece. Razlog su neučinkovitost terapije ili nuspojave. Ozbiljne nuspojave registrirane su kod 6 djece (9.43 %): milijarna tuberkuloza (anti TNF pripravak), septički artritis (antiTNF pripravak), herpes zoster (anti CD 20) i duboka venska tromboza (anti CD 20), sve po jedno dijete, anafilaktička reakcija (anti TNF pripravak) dvoje djece. Blaža registrirana nuspojava : osip (anti IL 6), 1 dijete (1.89 % )
----- ZAKLJUČAK: Iako biološka terapija daje odlične rezultate u liječenju reumatskih bolesti, zbog ozbiljnih nuspojava koje sa sobom donosi primjena iste, a zbog relativnog kratkog korištenja i istraživanja nuspojava u dječjoj dobi, potrebna je temeljita i odgovarajuća priprema te kontinuirano praćenje bolesnika koje se nastavlja i nakon primjene terapije. |
| Abstract (english) | INTRODUCTION: Biological therapy is very successful in treating children diseases but its side effects are not entirely known yet. Influence of therapy on children growth and maturation is also not well know and is subject of science research. AIM: We wanted to find out the severity and the frequency of the side effects of biological therapy in treating children that have rheumatology diseases. We also wanted to measure the time passed from the time of diagnosis to the start of the therapy and also the outcome of the therapy.
----- SUBJECTS AND METHODS: This retrospective study included 53 children with rheumatology diseases treated with biological therapy between 2008 - 2013, in Clinic for pediatrics, Institute for rhemuatology and immunology, in KBC Zagreb. We analyzed the medical documentation of those patients.
----- RESULTS: Between 2008 - 2013, 53 children were treated with biological therapy. Among them 21 were male and 32 were female. Mean time passed from the date of diagnosis until the start of the biological therapy was 3.698 years. In treatment, two kinds of biological therapy were administrated: antcytokine therapy, anti TNF preparation (etanrecept 18 children, adalimumab 22 children, infliximab 5 children), anti IL 6 (tocilizumab 3 children) and therapy aimed against B lymphocytes, anti CD 20 (rituximab 5 children). Therapy was changed in the treatment of 6 children because of the side effects and inefficacy. Serious side effects were noticed in 6 children: miliar tuberculosis, septic arthritis, herpes zoster, deep vein thrombosis (1 child had each) and anafilactic reaction (2 children). One mild local side effect was registered – an itch. 5 children were treated with sulfasalazine.
----- CONCLUSION: Biological therapy had excellent results but its been used for a relatively short time and has very serious side affects. Because of that very good preparation has to be done before administrating the therapy and constant monitoring of the patients is also necessary even after the end of the therapy. |
