title: Treatment with infliximab for pediatric Crohn's disease: Nationwide survey of Japan.
abstract: OBJECTIVE
  Childhood-onset inflammatory bowel disease (IBD) is characterized by extensive intestinal involvement and rapid early progression. Infliximab (IFX), cyclosporin (CYA), and tacrolimus (FK506) are increasingly used to treat pediatric IBD; however, their long-term effects and adverse events have not been properly investigated in pediatric patients. The aim of this study was to characterize the effects of these biologics and immunomodulators on pediatric IBD patients in Japan. Additionally, we assessed IFX use in pediatric patients with Crohn's disease (CD).
  
  
  METHODS
  A national survey of IFX, adalimumab, CYA, and FK506 use in pediatric IBD patients (< 17 years of age) was sent to 683 facilities in Japan from December 2012 to March 2013. Secondary questionnaires were sent to pediatric and adult practitioners with the aim of assessing the effectiveness and safety of IFX for pediatric CD patients.
  
  
  RESULTS
  The response rate for the primary survey was 61.2% (N  =  418). Among 871 pediatric CD patients, 284 (31.5%), 24, 4, and 15 received IFX (31.5%), adalimumab, CYA, and FK506, respectively, from 2000 to 2012. According to the secondary survey, extensive colitis (L3, Paris classification) was diagnosed in 69.4% of pediatric CD patients who received IFX. Regarding the effectiveness of IFX in this population, 54.7% (99/181) of patients were in remission, and 42.0% (76/181) were on maintenance therapy. However, 32.0% (58/181) of patients experienced adverse events, and one patient died of septic shock.
  
  
  CONCLUSIONS
  Infliximab is reasonably safe and effective in pediatric CD patients and should therefore be administered in refractory cases.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Hosoi
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ohtsuka
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kudo
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Matsunaga
authors.affiliation: PAL Children's Clinic, Gunma, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tomomasa
authors.affiliation: Department of Pediatrics, Osaka General Medical Center, Osaka, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tajiri
authors.affiliation: Inflammatory Bowel Centre, Yokohama City University Medical Centre, Yokohama, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Kunisaki
authors.affiliation: Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishige
authors.affiliation: Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamada
authors.affiliation: Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Arai
authors.affiliation: Department of Pediatrics, Osaka Medical College, Osaka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yoden
authors.affiliation: Department of Pediatrics, Kurume University Medical Center, Kurume, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Ushijima
authors.affiliation: Department of Pediatrics, Osaka Medical College, Osaka, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Aomatsu
authors.affiliation: Department of Pediatrics, Tokyo Women's Medical University Hospital, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Nagata
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Uchida
authors.affiliation: General Health Support Center, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Takeuchi
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
mesh_terms: D000293:Adolescent; D000367:Age Factors; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy* / Q000453:epidemiology*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D000069285:Infliximab / Q000009:adverse effects / Q000627:therapeutic use*; D007564:Japan / Q000453:epidemiology; D060046:Maintenance Chemotherapy; D008297:Male; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D000069285:Infliximab
keywords: Crohn's disease; infliximab; surgery; ulcerative colitis