Infliximab for ulcerative colitis in children and adolescents.
OBJECTIVE
To evaluate the efficacy of infliximab treatment in children and adolescents with ulcerative colitis (UC) defined as short and long-term clinical response and surgical avoidance.


BACKGROUND
Infliximab has been found to be effective at improving clinical symptoms, sparing steroid use, and inducing remission in children with medically refractory Crohn's disease. Several retrospective studies in children have shown clinical improvement with colectomy avoidance, but the numbers have been small.


METHODS
Medical records of all patients with steroid-resistant or dependent UC who received infliximab 5 to 10 mg/kg in a 36-month period at Children's Hospital and Regional Medical Center, Seattle, Washington were reviewed. Response to the medication was defined by posttreatment recategorization into Trulove and Witts "mild" category or better. The duration of response was defined as time between infusion and clinical relapse or colectomy.


RESULTS
Forty children and adolescents aged 2 to 20 years, received infliximab during the study period. Duration of follow-up ranged from 1 to 36 months with a median of 19 months. Four patients were lost to follow-up. Seventy percent of subjects responded to infliximab. Infliximab responders proceeded to surgery less frequently than nonresponders (P<0.001). No laboratory variables correlated with response. Infliximab was well tolerated.


CONCLUSIONS
Most children and adolescents with steroid-resistant or dependent UC respond to infliximab with clinical improvement. Response to infliximab also delays and may prevent need for surgery. Laboratory and clinical indicators do not predict response. Infliximab has a role in clinical improvement and surgery avoidance in pediatric patients with UC.
McGinnis
Jean K
JK
Division of Pediatric Gastroenterology, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Children's Hospital and Regional Medical Center, Seattle, WA, USA. Jeannie.mcginnis@seattlechildrens.org
Murray
Karen F
KF
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use; D006776:Hospitals, Pediatric; D006801:Humans; D000069285:Infliximab; D008297:Male; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005938:Glucocorticoids; D000069285:Infliximab