Infliximab Use in Children and Adolescents With Inflammatory Bowel Disease

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 45; no. 1; pp. 3 - 14
• Main Authors: Ridder, Lissy, Benninga, Marc A, Taminiau, Jan AJM, Hommes, Daan W, Deventer, Sander JH
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01.07.2007; Lippincott
• Subjects: Adolescent; Adult; Anti-Inflammatory Agents - adverse effects; Anti-Inflammatory Agents - immunology; Anti-Inflammatory Agents - therapeutic use; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - immunology; Antibodies, Monoclonal - therapeutic use; Bacterial diseases; Biological and medical sciences; Child; Crohn disease; Gastroenterology. Liver. Pancreas. Abdomen; Human bacterial diseases; Humans; Immunomodulators; Infectious diseases; Inflammatory bowel disease; Inflammatory Bowel Diseases - drug therapy; Infliximab; Medical sciences; Other diseases. Semiology; Pharmacology. Drug treatments; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tuberculosis and atypical mycobacterial infections; Tumor Necrosis Factor-alpha - immunology; Ulcerative colitis; Human; Cytokine; Monoclonal antibody; Mycobacterial infection; Inflammatory disease; Necrosis; Infection; Immunomodulator; Crohn disease; Adolescent-Child-Crohn disease-Inflammatory bowel disease-Infliximab-Ulcerative colitis; Treatment; Tuberculosis; Infliximab; Anticytokine; Adolescent; Bacteriosis; Digestive diseases; Intestinal disease; Tumor; Immunosuppressive agent; Child; Tumor necrosis factor α; Ulcerative colitis
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1097/MPG.0b013e31803e171c

ABSTRACT Infliximab is a chimeric monoclonal antibody (75% human, 25% murine) against tumor necrosis factor‐α, a cytokine with a central role in the pathogenesis of inflammatory bowel disease. Large randomized controlled trials have shown the efficacy and safety of infliximab for the induction and maintenance of remission in adult patients with active Crohn disease (CD). In children and adolescents, mostly small, nonrandomized, non–placebo‐controlled studies have supported the notion that infliximab is a potent drug in a population that does not respond to standard therapies. The safety of infliximab is of major concern, and the most frequent severe adverse events are related to severe infections and reactivation of tuberculosis. Non–life‐threatening infusion reactions occur rather frequently and seem to be related to the formation of antibodies. The indications for infliximab treatment are therapy‐resistant luminal CD (no efficacy or insufficient efficacy of conventional treatment) and therapy‐resistant fistulas. An efficient remission induction strategy consists of 3 initial infliximab infusions at 0, 2, and 6 weeks in a dosage of 5 mg/kg to sustain remission. Patients needing maintenance therapy are subsequently treated with an infliximab infusion every 8 weeks. There are indications that the early stages of CD may be more susceptible to immunomodulation, and the natural history of CD may be altered by the introduction of infliximab early in the disease process instead of waiting until conventional therapy has failed. Major points of discussion are whether infliximab maintenance treatment should be episodic (on demand) or scheduled and when infliximab therapy can be discontinued.