title: Corticosteroid therapy in the age of infliximab: acute and 1-year outcomes in newly diagnosed children with Crohn's disease.
abstract: OBJECTIVE
  The aim of this study was to describe 3-month and 1-year outcomes of children with Crohn's disease (CD) treated with corticosteroids within 30 days of diagnosis, with particular emphasis on the influence of infliximab on these outcomes. We also aimed to determine whether there are clinical or laboratory characteristics associated with corticosteroid therapy outcomes.
  
  
  METHODS
  Data from 109 children were drawn from a multicenter observational registry that was started in 2002. Clinical characteristics and data on corticosteroid and other therapies were recorded prospectively. Corticosteroid therapy outcomes at 3 months were defined as complete acute response, partial response, or corticosteroid resistance. At 1 year, corticosteroid responsiveness, dependence, and surgical rates were determined. Infliximab's influence on short- and long-term outcomes also was investigated.
  
  
  RESULTS
  At 3 months, 65 of 109 (60%) patients had a complete acute response to corticosteroids, 26 (24%) had a partial response, and 18 (17%) were corticosteroid resistant. At 1 year, 61% were corticosteroid responsive, 31% were corticosteroid dependent, and 8% required surgery. Irrespective of the duration of corticosteroid treatment, 16 of 24 of corticosteroid-dependent/resistant patients rapidly discontinued corticosteroids after starting infliximab. No clinical or laboratory characteristics at diagnosis predicted short-term outcome. Growth impairment at diagnosis increased risk for corticosteroid dependence or surgery at 1 year.
  
  
  CONCLUSIONS
  At 3 months, 84% of children had a complete or partial response to corticosteroids. However, despite concomitant immunomodulators, at 1 year 31% were corticosteroid dependent and 8% required surgery. Infliximab improves outcomes of corticosteroid-dependent/resistant patients because the duration of corticosteroid use can be controlled by initiating treatment with infliximab.
authors.affiliation: North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA. jmarkowi@nshs.edu
authors.forename: James
authors.initials: J
authors.lastname: Markowitz
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hyams
authors.forename: David
authors.initials: D
authors.lastname: Mack
authors.forename: Neal
authors.initials: N
authors.lastname: Leleiko
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: Subra
authors.initials: S
authors.lastname: Kugathasan
authors.forename: Marian
authors.initials: M
authors.lastname: Pfefferkorn
authors.forename: Adam
authors.initials: A
authors.lastname: Mezoff
authors.forename: Joel
authors.initials: J
authors.lastname: Rosh
authors.forename: Vasundhara
authors.initials: V
authors.lastname: Tolia
authors.forename: Anthony
authors.initials: A
authors.lastname: Otley
authors.forename: Anne
authors.initials: A
authors.lastname: Griffiths
authors.forename: M Susan
authors.initials: MS
authors.lastname: Moyer
authors.forename: Maria
authors.initials: M
authors.lastname: Oliva-Hemker
authors.forename: Robert
authors.initials: R
authors.lastname: Wyllie
authors.forename: Robert
authors.initials: R
authors.lastname: Rothbaum
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: J Fernando
authors.initials: JF
authors.lastname: Del Rosario
authors.forename: Sandra
authors.initials: S
authors.lastname: Hale
authors.forename: Trudy
authors.initials: T
authors.lastname: Lerer
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D008297:Male; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab