title: Infliximab delays but does not avoid the need for surgery in treatment-resistant pediatric Crohn' disease.
abstract: The aim of this study was to review the impact of infliximab therapy on children with treatment-resistant Crohn's disease. Treatment resistance was defined as clinically active disease despite >4 months of immunosuppressive therapy. The outcome variables were time to first remission, duration of remission and the need for surgery. 24 children received 90 infusions of infliximab (16 boys; median 10.3y, range 1.0-14.4y); all had three infusions as an induction course. 17 (70.8%) achieved clinical remission, with 14/17 (82.3%) relapsing within 4 months of the third infusion. 6/7 in the non-responding group and 8/17 of the responders required surgery with an insignificant difference in the median time to surgery (p=0.49). Four remain dependent on regular infliximab. Infliximab is well-tolerated and highly effective in achieving clinical remission in children with refractory Crohn's disease but may only delay and not avoid the need for surgery. Failure to achieve clinical remission by the 3rd infusion significantly increases the risk of surgery.
authors.affiliation: Department of Paediatrics, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: N A
authors.initials: NA
authors.lastname: Afzal
authors.forename: A
authors.initials: A
authors.lastname: Ozzard
authors.forename: S
authors.initials: S
authors.lastname: Keady
authors.forename: M
authors.initials: M
authors.lastname: Thomson
authors.forename: S
authors.initials: S
authors.lastname: Murch
authors.forename: R
authors.initials: R
authors.lastname: Heuschkel
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000379:methods*; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D004351:Drug Resistance / Q000187:drug effects*; D004359:Drug Therapy, Combination; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D000069285:Infliximab; D007262:Infusions, Intravenous; D008297:Male; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome