title: Efficacy and tolerance of infliximab in children and adolescents with Crohn's disease.
abstract: Infliximab, a monoclonal antibody against tumor necrosis factor-alpha, has been shown to be effective for the treatment of refractory Crohn's disease in adult patients, but experience in pediatrics is limited. This retrospective study included 88 children and adolescents, 39 girls and 49 boys, with a median age of 14 years (range 3.3-17.9). Infliximab was indicated for active disease (66%) and/or fistulas (42%) that were refractory to corticosteroids (70%), and/or other immunosuppressive (82%) agents, and/or parenteral nutrition (20%). Patients received 1 to 17 infusions (median 4) of 5 mg/kg (range 3.8-7.3) of infliximab during a median time period of 4 months (1-17 months). Infusion reaction was noted in 13 patients (15%), with a total of 16 reactions in 450 infusions (4%). At Day 90 after the first infusion of infliximab, symptoms improved in 49% of patients, whereas 29% of patients were in remission and 13% of patients relapsed. From Day 0 to Day 90, Harvey-Bradshaw score decreased from 7.5 to 2.8 (P < 0.001), C-reactive protein from 36 to 16 mg/L (P < 0.01), and 1-hour erythrocyte sedimentation rate from 35 to 17 mm (P < 0.01). Dosage of corticosteroids decreased from to 0.59 to 0.17 mg/kg/d (P < 0.001); 53% of patients could be weaned of corticosteroids and 92% of parenteral nutrition. Treatment with infliximab is well tolerated and effective in most children and adolescents with Crohn's disease that is refractory to conventional immunosuppressive therapy. Nevertheless, long-term efficacy remains to be shown, and further studies are urgently needed to precisely determine the best modality of continuing treatment.
authors.affiliation: Unité de Gastroentérologie Pédiatrique, Hôpital des Enfants, Place Amélie Raba Léon, Cedex, France. thierry.lamireau@chu-bordeaux.fr
authors.forename: Thierry
authors.initials: T
authors.lastname: Lamireau
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cézard
authors.forename: Alain
authors.initials: A
authors.lastname: Dabadie
authors.forename: Olivier
authors.initials: O
authors.lastname: Goulet
authors.forename: Alain
authors.initials: A
authors.lastname: Lachaux
authors.forename: Dominique
authors.initials: D
authors.lastname: Turck
authors.forename: Chantal
authors.initials: C
authors.lastname: Maurage
authors.forename: Alain
authors.initials: A
authors.lastname: Morali
authors.forename: Etienne
authors.initials: E
authors.lastname: Sokal
authors.forename: Dominique
authors.initials: D
authors.lastname: Belli
authors.forename: Joaquim
authors.initials: J
authors.lastname: Stoller
authors.forename: Samy
authors.initials: S
authors.lastname: Cadranel
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Ginies
authors.forename: Sheila
authors.initials: S
authors.lastname: Viola
authors.forename: Frédéric
authors.initials: F
authors.lastname: Huet
authors.forename: Jane
authors.initials: J
authors.lastname: Languepin
authors.forename: Catherine
authors.initials: C
authors.lastname: Lenaerts
authors.forename: Françoise
authors.initials: F
authors.lastname: Bury
authors.forename: Jacques
authors.initials: J
authors.lastname: Sarles
mesh_terms: D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology; D005060:Europe; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D000069285:Infliximab; D007262:Infusions, Intravenous; D008297:Male; D008499:Medical Records; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab