Infliximab, a monoclonal antibody against tumor necrosis factor-alpha, has been shown to be effective for the treatment of refractory Crohn's disease in adult patients, but experience in pediatrics is limited.
Dr Lamireau and colleagues in France, undertook a retrospective study including 88 children and adolescents, 39 girls and 49 boys, with a median age of 14 years (range 3.3-17.9).
The clinicians indicated infliximab for active disease (66%) and/or fistulas (42%) that were refractory to corticosteroids (70%), and/or other immunosuppressive (82%) agents, and/or parenteral nutrition (20%).
The investigators oversaw 1-17 (median 4) infusions of 5 mg/kg (range 3.8-7.3) infliximab for all patients during a median time period of 4 months (1-17 months).
|Day 90 after the first infusion of infliximab, symptoms improved in 49% of patients|
|Inflammatory Bowel Diseases|
The investigators noted the infusion reaction in 13 patients (15%), with a total of 16 reactions in 450 infusions (4%).
The researchers found that at day 90 after the first infusion of infliximab, symptoms improved in 49% of patients, whereas 29% of patients were in remission and 13% of patients relapsed.
In addition, from day 0 to day 90, the researchers noted that Harvey-Bradshaw score decreased from 7.5 to 2.8, C-reactive protein from 36 to 16 mg/L, and 1-hour erythrocyte sedimentation rate from 35 to 17 mm.
The dosage of corticosteroids decreased from to 0.59 to 0.17 mg/kg/d ; and the researchers were able to wean 53% of patients off corticosteroids and 92% off parenteral nutrition.
Dr Lamireau concluded, "Treatment with infliximab is well tolerated and effective in most children and adolescents with Crohn's disease that is refractory to conventional immunosuppressive therapy."
"Nevertheless, long-term efficacy remains to be shown, and further studies are urgently needed to precisely determine the best modality of continuing treatment."