title: Efficacy of Early Infliximab Treatment for Pediatric Crohn's Disease: A Three-year Follow-up.
abstract: OBJECTIVE
  To investigate the efficacy of early infliximab use and to follow the progress of pediatric cases of Crohn's disease for 3 years.
  
  
  METHODS
  We reviewed the medical records of 28 pediatric patients who had been treated with infliximab for Crohn's disease. Eighteen patients (the 'top-down' group) received infliximab and azathioprine for induction and maintenance therapy for the first year, and then were treated with azathioprine for 2 additional years. Ten patients who were refractory to conventional therapy were categorized in the 'step-up' group. All patients were followed for at least 36 months. Treatment efficacy was assessed by the relapse rate using the pediatric Crohn's disease activity index (PCDAI) score in each group at 12, 24, and 36 months. Blood samples were available from 10 patients, and were used to assess antibody to infliximab (ATI).
  
  
  RESULTS
  The relapse rate in 'top-down' group was lower than that in 'step-up' group at 1, 2, and 3 years. But, just the relapse rate at the 2 years was significantly different. At 3 years, the relapse rate according to different characteristic variables (sex, age at diagnosis, involvement, PCDAI at diagnosis) was not significantly different. Only one patient treated with infliximab had an adverse event, consisting of dyspnea and tachycardia. ATI was not detected in the blood samples from 10 patients.
  
  
  CONCLUSIONS
  Early induction with infliximab at diagnosis ('top-down' therapy) is effective for reducing the relapse rate compared to conventional therapies in pediatric Crohn's disease possibly for up to 3 years.
authors.affiliation: Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea.
authors.forename: Yun Seok
authors.initials: YS
authors.lastname: Lee
authors.forename: Sang Hun
authors.initials: SH
authors.lastname: Baek
authors.forename: Mi Jin
authors.initials: MJ
authors.lastname: Kim
authors.forename: Yoo Min
authors.initials: YM
authors.lastname: Lee
authors.forename: Yoon
authors.initials: Y
authors.lastname: Lee
authors.forename: Yon Ho
authors.initials: YH
authors.lastname: Choe
keywords: Infliximab; Pediatric Crohn's disease; Relapse rate; Top-down treatment