Long-term outcome of maintenance infliximab therapy in children with Crohn's disease

✍ Scribed by Jeffrey S. Hyams; Trudy Lerer; Anne Griffiths; Marian Pfefferkorn; Subra Kugathasan; Jonathan Evans; Anthony Otley; Ryan Carvalho; David Mack; Athos Bousvaros; Joel Rosh; Petar Mamula; Marsha Kay; Wallace Crandall; Maria Oliva-Hemker; David Keljo; Neal LeLeiko; James Markowitz

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 218 KB
• Volume: 15
• Category: Article
• ISSN: 1078-0998
• DOI: 10.1002/ibd.20845

✦ Synopsis

Background: Infliximab therapy has short-term benefits in children with moderate-to-severe Crohn's disease (CD). We assessed the long-term outcome of infliximab maintenance therapy in children with CD.

Methods:

We performed a multicenter cohort study of 729 pediatric patients with CD enrolled in the Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry. Children younger than 16 years and newly diagnosed with CD were eligible for this study. Disease and medication information were collected prospectively from the treating physician at diagnosis, 30 days, and quarterly thereafter. No interventions were specified, per protocol.

Results:

In all, 202 of 729 patients received infliximab: 62%, 23%, and 15% within 1, 1-2, and Ͼ2 years of diagnosis, respectively. The mean age at infliximab initiation was 12.7 years. A total of 158 infliximab-treated patients received maintenance therapy, 29 episodic (8 converted to maintenance), and 15 had incomplete followup. Among 128 patients administered maintenance infliximab and followed for Ն1 year, concomitant medications at infliximab initiation included corticosteroids (52%) and immunomodulators (90%). By 1, 2, and 3 years, Ͻ10% of patients continuing on maintenance infliximab were receiving corticosteroids (P Ͻ 0.001). Following maintenance therapy initiation, 26%, 44%, and 33% of patients continuing on maintenance infliximab over 0 -1, 1-2, and 2-3 years, respectively, had clinically inactive disease not requiring corticosteroids or surgery. The likelihood of continuing maintenance infliximab at 1, 2, and 3 years was 93%, 78%, and 67%, respectively.

Conclusions:

Infliximab maintenance therapy was a durable and effective treatment that was associated with prolonged corticosteroid withdrawal over a 3-year period in children with CD.