title: Outcomes following infliximab therapy for pediatric patients hospitalized with refractory colitis-predominant IBD.
abstract: OBJECTIVE
  Although randomized trials demonstrated the efficacy of infliximab for both pediatric Crohn disease and ulcerative colitis (UC), few patients in these studies exhibited colitis requiring hospitalization. The aims of this study were to determine the rate of subsequent infliximab failure and dose escalation in pediatric patients who started taking infliximab during hospitalization for colitis-predominant IBD, and to identify potential predictors of these endpoints.
  
  
  METHODS
  This is a single-center retrospective cohort study of patients admitted from 2005 to 2010 with Crohn colitis, UC, or IBD-unspecified (IBD-U) and initiated on infliximab.
  
  
  RESULTS
  We identified 29 patients (12 Crohn colitis, 15 UC, and 2 IBD-U; median age 14 years) with a median follow-up of 923 days. Eighteen patients (62%) required infliximab dose escalation (increased dose or decreased infusion interval). Infliximab failure occurred in 18 patients (62%) because of ineffectiveness in 12 (67%) and adverse reactions in 6 (33%). Twelve patients (41%) underwent colectomy. Subsequent need for infliximab dose escalation was associated with lower body mass index z score (P = 0.01), lower serum albumin (P = 0.03), and higher erythrocyte sedimentation rate (ESR) (P = 0.002) at baseline. ESR predicted subsequent infliximab dose escalation with an area under the curve of 0.89 (95% confidence interval [CI] 0.72-1.00) and a sensitivity and specificity at a cutoff of 38 mm/hour of 0.79 (95% CI 0.49-0.95) and 0.88 (95% CI 0.47-0.99), respectively.
  
  
  CONCLUSIONS
  Most hospitalized pediatric patients with colitis treated with infliximab require early-dose escalation and fail the drug long term. Low body mass index and albumin and high ESR, may identify patients who would benefit from a higher infliximab starting dose.
authors.affiliation: *Department of Pediatrics †Department of Biostatistics ‡Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Tolulope O
authors.initials: TO
authors.lastname: Falaiye
authors.forename: Keisha R
authors.initials: KR
authors.lastname: Mitchell
authors.forename: Zengqi
authors.initials: Z
authors.lastname: Lu
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Saville
authors.forename: Sara N
authors.initials: SN
authors.lastname: Horst
authors.forename: Dedrick E
authors.initials: DE
authors.lastname: Moulton
authors.forename: David A
authors.initials: DA
authors.lastname: Schwartz
authors.forename: Keith T
authors.initials: KT
authors.lastname: Wilson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D001799:Blood Sedimentation; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D000069285:Infliximab; D008297:Male; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D012709:Serum Albumin; D000069285:Infliximab
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