Response to infliximab is related to disease duration in paediatric Crohn's disease

Abstract

Summary Background : Infliximab is an effective therapy in adult patients with refractory and fistulizing Crohn's disease. Experience in children is still limited. Aim : To evaluate the experience in 22 children and adolescents treated with infliximab with refractory and/or fistulizing Crohn's disease, and to compare duration of response in children between early Crohn's disease and late Crohn's disease. Methods : The experience in 22 children and adolescents treated with a total of 73 infusions was evaluated retrospectively. Treatment indication was refractory Crohn's disease in 9/22 patients, fistulizing Crohn's disease in 7/22 patients and both these conditions in 6/22. All patients with refractory Crohn's disease had late Crohn's disease (> 1 year), whereas 6/13 patients with fistulas had early disease (< 1 year). Results : Mean Paediatric Crohn's Disease Activity Index (PCDAI) decreased from 41.2 to 16.2 at 4 weeks (P < 0.01), and to 15.4 at 18 weeks (P < 0.01). Mean PCDAI at 18 weeks in children with early Crohn's disease and late Crohn's disease was 5.5 and 18.1, respectively (P < 0.05). Complete closure of fistulas was obtained in 5/6 children with early Crohn's disease and in 2/7 children with late Crohn's disease. Immediate adverse reactions were observed in two children. Conclusions : Infliximab is a highly effective treatment in children and adolescents with both severe refractory or fistulizing Crohn's disease. Children with early Crohn's disease have a higher chance of prolonged response to infliximab than children with late Crohn's disease.

Predictors of response to infliximab in paediatric perianal Crohn's disease

“…One small retrospective study from 2003 showed that rate of response to IFX in children with perianal CD was lower in patients who had a disease duration of more than 1 year. 23 However, disparities in treatment administration and overlap between the periods before and after IFX became available prevent from any formal conclusion. None of the concomitant treatments received at baseline was associated with 1-year response or relapse during the year of follow-up.…”

Infliximab treatment time and the mucosal healing effect in pediatric patients with severe Crohn’s disease – own experience

“…Their number quickly decreased, however, when therapy was not continued. Better clinical effect was also associated with short disease duration of 1-2 years [14,15], but that conclusion was later questioned when further studies were carried out in a larger population of children [16]. Another large research project was REACH, a prospective, multi-center, randomized study based on the analysis of therapy results in 112 children with moderately severe and severe CD.…”

Infliximab therapy in pediatric Crohn&rsquo;s disease: a review

“…28,29 Infliximab use in children Studies evaluating the safety and efficacy of infliximab in children were first reported in several non-randomized studies. [30][31][32][33][34] These initial studies showed that the response and remission rates (both partial and complete) were far superior compared to conventional therapy. Interestingly, its efficacy in children appeared to be higher than in adult.…”

“…Interestingly, its efficacy in children appeared to be higher than in adult. 31,32 In a multicenter, open-label, dose-blinded trial (n = 21), Baldassano and coworkers demonstrated the efficacy and safety of a single infusion of infliximab in the treatment of pediatric CD. During the 12-week duration of the study, 100% achieved a clinical response and 48% achieved clinical remission, with significant improvements in the pediatric CD activity index (PCDAI), modified CDAI, erythrocyte sedimentation rate, and other outcome variables of interest.…”