title: Predictors of response to infliximab in paediatric perianal Crohn's disease.
abstract: BACKGROUND
  It is reported that 27-54% of paediatric patients with perianal Crohn's disease (CD) do not respond to infliximab (IFX).
  
  
  OBJECTIVE
  To identify predictors of response to IFX in paediatric perianal CD.
  
  
  METHODS
  A retrospective cohort study of 101 paediatric patients treated with IFX between 2000 and 2011 for perianal CD in 22 French hospitals of the GETAID pédiatrique network was performed. Response was monitored after induction therapy and at 1 year. Complete response was defined by closure of all fistulas and complete healing of ulcers. Associations between baseline characteristics and (i) 1-year response and (ii) time of first relapse among initial responders were tested by logistic regression and Cox model respectively.
  
  
  RESULTS
  Eighty-nine patients (88%) responded to induction therapy (36 partial/53 complete). At 1 year, 76 patients (75%) were responders (22 partial/54 complete). Predictors of 1-year response were: number of fistulas ≤1 (OR: 3.76, 95% CI: 1.20-11.77, P = 0.03) and baseline Harvey-Bradshaw index <5 (OR: 3.72, 95% CI: 1.10-12.60, P = 0.03). Predictors of relapse among initial responders were: CD duration <10 months (OR: 3.31, 95% CI: 1.34-8.19, P = 0.0097) and number of fistulas >1 (OR: 2.79, 95% CI: 1.12-6.95, P = 0.028). Combined therapy with an immunomodulator was not associated with 1-year response or time of relapse.
  
  
  CONCLUSIONS
  Those patients with perianal Crohn's disease have better outcomes if they have less fistulas, a low baseline Harvey-Bradshaw Index or a longer duration of Crohn's disease.
authors.affiliation: Département de Pédiatrie, Centre Hospitalier Universitaire de Caen, Caen, France; Université de Basse Normandie, Caen, France.
authors.forename: C
authors.initials: C
authors.lastname: Dupont-Lucas
authors.forename: A
authors.initials: A
authors.lastname: Dabadie
authors.forename: C
authors.initials: C
authors.lastname: Alberti
authors.forename: F M
authors.initials: FM
authors.lastname: Ruemmele
mesh_terms: D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005402:Fistula / Q000188:drug therapy*; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D000069285:Infliximab; D008297:Male; D016017:Odds Ratio; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab