title: Infliximab therapy in children with Crohn's disease: a one-year evaluation of efficacy comparing 'top-down' and 'step-up' strategies.
abstract: 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.
authors.affiliation: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Mi Jin
authors.initials: MJ
authors.lastname: Kim
authors.forename: Jong Seung
authors.initials: JS
authors.lastname: Lee
authors.forename: Ji Hyuk
authors.initials: JH
authors.lastname: Lee
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Yon Ho
authors.initials: YH
authors.lastname: Choe
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab