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

• Published in: Alimentary pharmacology & therapeutics Vol. 18; no. 4; pp. 425 - 431
• Main Authors: Lionetti, P., Bronzini, F., Salvestrini, C., Bascietto, C., Canani, R. Berni, Dé Angelis, G. L., Guariso, G., Martelossi, S., Papadatou, B., Barabino, A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 15-08-2003
• Subjects: Adolescent; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - adverse effects; Child; Child, Preschool; Crohn Disease - complications; Crohn Disease - drug therapy; Female; Follow-Up Studies; Gastrointestinal Agents - administration & dosage; Gastrointestinal Agents - adverse effects; Humans; Infliximab; Infusions, Intravenous; Intestinal Fistula - complications; Intestinal Fistula - drug therapy; Male; Retrospective Studies; Treatment Outcome
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1046/j.1365-2036.2003.01672.x

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.