title: The duration of effect of infliximab maintenance treatment in paediatric Crohn's disease is limited.
abstract: BACKGROUND
  Infliximab is effective for induction and maintenance of remission in children with moderately to severely active Crohn's disease (CD).
  
  
  OBJECTIVE
  To evaluate the long-term efficacy of infliximab treatment in paediatric CD.
  
  
  METHODS
  In this observational, multicentre study, all paediatric CD patients in The Netherlands treated with infliximab from October 1992 to November 2009 and with minimal follow-up of 3 months since start of infliximab, were studied.
  
  
  RESULTS
  One hundred and fifty-two CD patients [81M; median age at start of infliximab 15.0 years (IQR 13.1-16.4)] received a median number of 10.5 infliximab infusions (IQR 6-21). Median follow-up after start of infliximab was 25 months (IQR 13-40). Kaplan-Meier analysis showed that the cumulative probability of losing response to infliximab in patients who initially required repeated infusions was 13%, 40% and 50% after 1, 3 and 5 years, respectively. Seventy-four patients (49%) needed dose adjustments, with a median time to any adjustment of 6 months.
  
  
  CONCLUSIONS
  Duration of effect of infliximab is limited as 50% of patients on infliximab maintenance treatment lose their therapeutic response after 5 years. Dose adjustments after start of infliximab are frequently needed to regain therapeutic benefit. These findings emphasise the need for effective, long-term treatment strategies for paediatric CD.
authors.affiliation: Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands. c.i.debie@erasmusmc.nl
authors.forename: C I
authors.initials: CI
authors.lastname: De Bie
authors.forename: T Z
authors.initials: TZ
authors.lastname: Hummel
authors.forename: A
authors.initials: A
authors.lastname: Kindermann
authors.forename: F T M
authors.initials: FT
authors.lastname: Kokke
authors.forename: G M
authors.initials: GM
authors.lastname: Damen
authors.forename: C M F
authors.initials: CM
authors.lastname: Kneepkens
authors.forename: P F
authors.initials: PF
authors.lastname: Van Rheenen
authors.forename: J J
authors.initials: JJ
authors.lastname: Schweizer
authors.forename: J H
authors.initials: JH
authors.lastname: Hoekstra
authors.forename: O F
authors.initials: OF
authors.lastname: Norbruis
authors.forename: W E
authors.initials: WE
authors.lastname: Tjon A Ten
authors.forename: A C
authors.initials: AC
authors.lastname: Vreugdenhil
authors.forename: J M
authors.initials: JM
authors.lastname: Deckers-Kocken
authors.forename: C F M
authors.initials: CF
authors.lastname: Gijsbers
authors.forename: J C
authors.initials: JC
authors.lastname: Escher
authors.forename: L
authors.initials: L
authors.lastname: De Ridder
mesh_terms: D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D009426:Netherlands; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab