Similar to a previous recent study (How Long Will Infliximab Work? | gutsandgrowth), another large retrospective review confirms that infliximab has sustained effectiveness in the majority of children with Crohn’s disease (CD) (Inflamm Bowel Dise 2014; 20: 1177-86).
This study examined a 195 patients with a median age of 13.9 years from the years 2000-2011. Key findings:
- Based on physician global assessment and pediatric Crohn’s activity index ≤10, 81% experienced a complete response. Only 40 patients had endoscopic reassessment. Among the 22 of these patients considered to be in a complete response, 16 (73%) had complete mucosal healing.
- Despite optimization (based on clinical symptoms) in 35%, complete responders experienced a loss of response at a rate of 2% to 6% per year over 5 years.
- In this cohort, combination therapy with at least 30 weeks of immunomodulator therapy improved durability of response. Since 2006, the authors indicate that “our preference has been to use concomitant methotrexant rather than thiopurines” in boys.
- Infliximab was well-tolerated. However, severe infusion reactions were noted in 5% at some time point, 8% had psoratiform skin lesions, and 24% had elevated ALT.
- Clinical response to infliximab was associated with enhanced linear growth.
Take-home message (from the authors): “the clinical response and growth data presented argue in favor of early treatment.”
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