title: Duration of disease may predict response to infliximab in pediatric ulcerative colitis.
abstract: BACKGROUND
  Infliximab (IFX) is an established treatment modality for moderate to severe pediatric ulcerative colitis (UC). The purpose of this study was to identify clinical and laboratory parameters, which predict response to IFX in pediatric UC defined by colectomy as the primary outcome measure. Postsurgical complications were examined as well.
  
  
  METHODS
  A retrospective chart review was performed on children younger than 19 years who received IFX therapy at Texas Children's Hospital, Houston, Texas for the treatment of UC from January 2005 to April 2012. Demographics, laboratory data, clinical subtype, duration of disease, transfusion requirement, number of IFX infusions, concurrent medications, and postoperative complication with regard to IFX exposure were examined.
  
  
  RESULTS
  Forty-seven patients (22 male and 25 female; average age at diagnosis: 11.4 y) received IFX. Twenty-six (55.3%) required colectomy, 20 (42.6%) of which occurred within a year of therapy initiation. Disease duration <20 months before IFX initiation, increased the likelihood of a colectomy within a year [OR: 3.8 (95% CI, 1.6-13.3), P=0.044]. Blood transfusion requirement before IFX was associated with higher rates of colectomy within a year [OR: 9.78 (95% CI, 2.2-43.3), P=0.0028]. Preoperative exposure to IFX within 8 weeks did not significantly increase postoperative complications (P=0.26). Serum albumin levels at diagnosis did not predict colectomy.
  
  
  CONCLUSIONS
  Shorter disease duration and need for blood transfusion may be useful indicators of limited response to IFX in pediatric UC.
authors.affiliation: Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
authors.forename: Sabina A V
authors.initials: SA
authors.lastname: Mir
authors.forename: Dorottya
authors.initials: D
authors.lastname: Nagy-Szakal
authors.forename: Elliot O'Brian
authors.initials: EO
authors.lastname: Smith
authors.forename: Mark A
authors.initials: MA
authors.lastname: Gilger
authors.forename: Richard
authors.initials: R
authors.lastname: Kellermayer
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003082:Colectomy / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006776:Hospitals, Pediatric; D006801:Humans; D000069285:Infliximab; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013781:Texas; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab