Efficacy of early treatment with infliximab in pediatric Crohn's disease.
OBJECTIVE
To investigate the effectiveness of early infliximab use for induction and maintenance therapy in pediatric Crohn's disease.


METHODS
We performed a retrospective chart review of 36 patients with Crohn's disease. Ten patients (group A) were treated with mesalamine after induction therapy with oral prednisolone, and 13 patients (group B) were treated with azathioprine after induction therapy with oral prednisolone. Thirteen patients (group C) received infliximab and azathioprine for induction and maintenance therapy for the first year, and were treated with azathioprine after 1 year. All patients were followed for at least 24 mo. Efficacy was determined by the relapse rate using the pediatric Crohn's disease activity index score in each group at 12 and 24 mo.


RESULTS
At the 1 year follow-up, the relapse rate (23.1%, 3 of 13 patients) in group C was lower than that (61.5%, 8 of 13 patients) in group B (P = 0.047). At the 2 years follow-up, the relapse rate (38.5%, 5 of 13 patients) in group C was lower than that (76.9%, 10 of 13 patients) in group B (P = 0.047). Adverse events in group C were fewer than in groups A and B.


CONCLUSIONS
Early induction with infliximab at diagnosis, known as "top-down" therapy, was effective for reducing the relapse rate compared to conventional therapies for at least 2 years.
Lee
Jong Seung
JS
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam, Seoul 135-710, South Korea.
Lee
Jee Hyun
JH
Lee
Ji Hyuk
JH
Lee
Hye Jin
HJ
Kim
Mi Jin
MJ
Lee
Hae Jeong
HJ
Choe
Yon Ho
YH
D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D001379:Azathioprine / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy* / Q000517:prevention & control; D005260:Female; D006801:Humans; D000069285:Infliximab; D007723:Korea; D008297:Male; D019804:Mesalamine / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage; D012189:Retrospective Studies; D055502:Secondary Prevention; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D019804:Mesalamine; D011239:Prednisolone; D000069285:Infliximab; D001379:Azathioprine