Infliximab therapy in children with Crohn's disease: a one-year evaluation of efficacy comparing 'top-down' and 'step-up' strategies.
BACKGROUND
The aim of this study was to evaluate the efficacy of 'top-down' regimens for the treatment of paediatric Crohn's disease (CD) and to compare it with the effects of 'step-up' treatment.


METHODS
We evaluated patients treated with 'top-down' and 'step-up' regimens at 8 weeks after the initiation of treatment, with 1 year of follow-up. Of the 29 patients who received infliximab, 11 cases refractory to conventional therapy were categorized as the 'step-up' group; and 18 cases, with moderate to severe CD, were categorized as the 'top-down' group. Treatment efficacy was assessed by Pediatric Crohn's Disease Activity Index (PCDAI) scores.


RESULTS
At 8 weeks, remission was achieved in three of 11 patients in the 'step-up' group and 16 of 18 patients in the 'top-down' group. At 1 year, remission was maintained in five of 11 patients and in 15 of 18 patients, in the 'step-up' and 'top-down' groups, respectively. The serum albumin level, erythrocyte sedimentation rate, PCDAI score and perianal fistula status demonstrated significant improvement in the 'top-down' group.


CONCLUSIONS
In paediatric patients with CD, the infliximab 'top-down' strategy resulted in superior outcomes when compared to the 'step-up' strategy for inducing and maintaining remission at 8 weeks and 1 year posttreatment.
Kim
Mi Jin
MJ
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Lee
Jong Seung
JS
Lee
Ji Hyuk
JH
Kim
Jae Young
JY
Choe
Yon Ho
YH
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D008297:Male; D012074:Remission Induction / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab