Infliximab Delays but Does Not Avoid the Need for Surgery in Treatment-Resistant Pediatric Crohn’ Disease

Abstract

The aim of this study was to review the impact of infliximab therapy on children with treatment-resistant Crohn's disease. Treatment resistance was defined as clinically active disease despite >4 months of immunosuppressive therapy. The outcome variables were time to first remission, duration of remission and the need for surgery. 24 children received 90 infusions of infliximab (16 boys; median 10.3y, range 1.0-14.4y); all had three infusions as an induction course. 17 (70.8%) achieved clinical remission, with 14/17 (82.3%) relapsing within 4 months of the third infusion. 6/7 in the non-responding group and 8/17 of the responders required surgery with an insignificant difference in the median time to surgery (p=0.49). Four remain dependent on regular infliximab. Infliximab is well-tolerated and highly effective in achieving clinical remission in children with refractory Crohn's disease but may only delay and not avoid the need for surgery. Failure to achieve clinical remission by the 3rd infusion significantly increases the risk of surgery.

Efficacy of Infliximab in Pediatric Crohnʼs Disease: A Randomized Multicenter Open-Label Trial Comparing Scheduled to On Demand Maintenance Therapy

“…As in adult patients, treatment with IFX probably postpones but does not diminish the need for surgery. 33 Safety analyses showed no major adverse events in this study during the 60-week observation period. A large number of mild and uncomplicated infectious episodes were noted, which are not necessarily related to CD nor the immunomodulatory or biological therapy.…”

Surgery for children with Crohn's disease: indications, complications and outcome

“…The use of Infliximab in children has, however, been associated with a delay in surgery rather than its avoidance 26. An additional issue in relation to the use of biologic agents in young patients with Crohn's disease is the development of antibodies to these medications, and subsequent treatment resistance 27.…”

Natural History of Pediatric-onset Inflammatory Bowel Disease

“…The increasing use of immunomodulators and antitumor necrosis factors may reduce the surgery rates over time. However, short-term data from Afzal et al 54 showed that despite achieving clinical remission in 70% of CD children with infliximab, 58% still required surgery within the next 12 months.…”