Infliximab dependency in pediatric Crohn's disease: Long-term follow-up of an unselected cohort

[Guest guest]

http://www3.interscience.wiley.com/cgi-bin/abstract/117860974/ABSTRACT?CRETRY=1 & SRETRY=0

Original Article

Infliximab dependency in pediatric Crohn's disease: Long-term follow-up of an unselected cohort

Lissy de Ridder, MD, PhD 1 2 *, Edmond H.H.M. Rings, MD, PhD 3, Gerard M. Damen, MD 4, C.M. Kneepkens, MD, PhD 2, Joachim J. Schweizer, MD, PhD 5, Freddy T.M. Kokke, MD 6, Marc A. Benninga, MD, PhD 7, Obbe F. Norbruis, MD 8, J. Hans Hoekstra, MD, PhD 9, Carolien F.M. Gijsbers, MD 10, Johanna C. Escher, MD, PhD 1

1Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, Netherlands2VU University Medical Center, Amsterdam, Netherlands3University Medical Center Groningen, University of Groningen/Beatrix Children's Hospital, Groningen, Netherlands4UMC St Radboud Hospital, Nijmegen, Netherlands5LUMC, Leiden, Netherlands6UMC Wilhelmina Children's Hospital, Utrecht, Netherlands7Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands8Isala Klinieken, Zwolle, Netherlands9Hieronymus Bosch Hospital, s-Hertogenbosch, Netherlands10na Children's Hospital, Den Haag, Netherlands

email: Lissy de Ridder (l.deridder@...)

*Correspondence to Lissy de Ridder, Pediatric Gastroenterology Department, Erasmus Medical Center/Sophia Children's Hospital Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands

Keywords

pediatrics • biologic therapies • adverse events

Abstract

Background: Infliximab is effective for induction and maintenance of remission in Crohn's disease. It is unknown how long patients should be kept on infliximab therapy. The primary aim of this study was to assess duration of effective maintenance therapy and infliximab dependency in pediatric CD patients initially responding to infliximab therapy.

Methods: All pediatric patients treated with infliximab by pediatric gastroenterologists in the Netherlands because of severe luminal or fistulizing CD with initial response to infliximab therapy were reviewed. Duration of therapy, clinical response and adverse events were recorded.

Results: Sixty-six CD patients (37 boys) in 10 hospitals were initially responding to infliximab therapy. Mean age at the start of infliximab therapy was 14.5 years (range, 8.1-18.5 years). Mean follow-up since infliximab was started was 41.3 months (range 12-165). In total, 991 infusions were administered. Analysis demonstrates that 15.2% of patients had prolonged response, while 56.1% were infliximab dependent and 28.8% lost response. In total, 10 patients (15.2%) developed an infection during infliximab therapy and 8 (12.1%) had an immediate allergic reaction.

Conclusions: Good clinical response to maintenance infliximab therapy was seen in 70% of patients. Infliximab maintenance therapy seems very effective and safe in pediatric CD. However, more than half of the patients in this cohort is dependent on repeated infliximab infusions. The number of infliximab infusions received when patients lost response to infliximab was diverse. There was no statistical difference regarding response to infliximab therapy when started early as compared to later in the course of Crohn's disease.

(Inflamm Bowel Dis 2007)

Received: 12 July 2007; Accepted: 6 October 2007

Digital Object Identifier (DOI)10.1002/ibd.20329 About DOI