Infliximab dependency in pediatric Crohn's disease: long-term follow-up of an unselected cohort.
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.
de Ridder
Lissy
L
Erasmus Medical Center/Sophia Children's Hospital, Dr. Molewaterplein 60, Rotterdam, Netherlands. l.deridder@erasmusmc.nl
Rings
Edmond H H M
EH
Damen
Gerard M
GM
Kneepkens
C M Frank
CM
Schweizer
Joachim J
JJ
Kokke
Freddy T M
FT
Benninga
Marc A
MA
Norbruis
Obbe F
OF
Hoekstra
J Hans
JH
Gijsbers
Carolien F M
CF
Escher
Johanna C
JC
D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D008297:Male; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab