title: [The clinical and endoscopic efficacy of step-up and top-down infliximab therapy in Crohn's disease].
abstract: OBJECTIVE
  To compare the efficacy of step-up and top-down infliximab therapy on patients with Crohn's disease (CD).
  
  
  METHODS
  A prospective and open-label study was performed by the First Affiliated Hospital of SUN Yat-sen University during September 2007 to December 2010. Active CD patients who were refractory to steroid/immunomodulator or who were steroid-dependent were enrolled into step-up group. Active CD patients who had no steroid or immunomodulator therapy before were enrolled into top-down group. All patients were intravenously infused with infliximab of 5 mg/kg body weight in an induction regimen of 3 doses at week 0, 2 and 6, followed by maintenance dosing every 8 weeks beginning at week 14. The clinical and endoscopic follow up lasted 30 weeks. Clinical symptoms and mucosal healing status under endoscopy were evaluated by follow-up at week 10 and 30.
  
  
  RESULTS
  Forty-one CD patients were enrolled, with 24 in step-up group and 17 in top-down group. There were significant differences in disease duration (P = 0.006), combination therapy (P < 0.001) and severity of disease (P = 0.011) in baseline between step-up and top-down groups. At week 10 and 30 during treatment, the clinical remission rates in step-up group were 45.8% (11/24) and 58.3% (14/24) respectively; the mucosal healing rates in step-up group were 33.3% (8/24) and 54.2% (13/24) respectively; the clinical remission rates in top-down group were 70.6% (12/17) and 82.4% (14/17) respectively; and the mucosal healing rates in top-down group were 35.3% (6/17) and 52.9% (9/17) respectively. No significant differences in clinical remission and mucosal healing rates at both week 10 and 30 were observed between the two groups. The prevalences of adverse events in step-up and top-down group were 41.7% (10/24) and 29.4% (5/17) respectively (P = 0.422).
  
  
  CONCLUSIONS
  Both step-up and top-down infliximab therapy can induce remission in more than half of CD patients, while top-down therapy might be more beneficiary to symptom and endoscopic remission.
authors.affiliation: Department of Gastroenterology, SUN Yat-sen University, Guangzhou, China.
authors.forename: Ying-lian
authors.initials: YL
authors.lastname: Xiao
authors.forename: Bai-li
authors.initials: BL
authors.lastname: Chen
authors.forename: Yao
authors.initials: Y
authors.lastname: He
authors.forename: Xiang
authors.initials: X
authors.lastname: Gao
authors.forename: Mei-juan
authors.initials: MJ
authors.lastname: Huang
authors.forename: Pin-jin
authors.initials: PJ
authors.lastname: Hu
authors.forename: Min-hu
authors.initials: MH
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D000069285:Infliximab