Monotherapy With Infliximab Versus Combination Therapy in the Maintenance of Clinical Remission in Children With Moderate to Severe Crohn Disease

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 60; no. 5; pp. 580 - 585
• Main Authors: Kierkuś, Jarosław, Iwańczak, Barbara, Wegner, Agnieszka, Dadalski, Maciej, Grzybowska‐Chlebowczyk, Urszula, Łazowska, Izabella, Maślana, Jolanta, Toporowska‐Kowalska, Ewa, Czaja‐Bulsa, Grażyna, Mierzwa, Grażyna, Korczowski, Bartosz, Czkwianianc, Elżbieta, Żabka, Alicja, Szymańska, Edyta, Krzesiek, Elżbieta, Więcek, Sabina, Sładek, Małgorzata
• Format: Journal Article
• Language: English
• Published: United States by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology 01.05.2015
• Subjects: Adolescent; Azathioprine - therapeutic use; Child; children; Crohn disease; Crohn Disease - drug therapy; Drug Therapy, Combination; Female; Gastrointestinal Agents - adverse effects; Gastrointestinal Agents - therapeutic use; Humans; Immunosuppressive Agents - therapeutic use; infliximab; Infliximab - adverse effects; Infliximab - therapeutic use; Maintenance Chemotherapy - methods; Male; Methotrexate - therapeutic use; Remission Induction; Severity of Illness Index
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1097/MPG.0000000000000684

ABSTRACT Objectives: The aim of the present study was to compare the efficacy and safety of 2 protocols of maintenance therapy with infliximab (IFX) and an immunomodulatory agent in pediatric patients with Crohn disease (CD): withdrawal of immunomodulators versus continuation of immunosuppressants. Methods: The present multicenter randomized open‐label trial included 99 patients with CD (ages 14.5 ± 2.6 years) who were administered IFX (5 mg/kg body weight) along with an immunomodulatory agent (azathioprine 1.5–3 mg/kg body weight per day, methotrexate 10–25 mg/week). After 10 weeks of the induction therapy, 84 responders were centrally randomized into 1 of the following groups: group I (n = 45) in which IFX and an immunomodulatory agent were continued up to week 54 and group II (n = 39) in which the immunomodulatory agent was discontinued after 26 weeks. Results: The induction therapy was reflected by a significant decrease in Pediatric Crohn's Disease Activity Index (PCDAI) and Simplified Endoscopic Activity Score for Crohn's Disease (SES‐CD) values. After the maintenance phase, the analyzed groups did not differ significantly in terms of the clinical response loss rates and final PCDAI and SES‐CD scores. Furthermore, no significant intragroup differences were documented between mean PCDAI scores determined at the end of induction and maintenance phases. Intensification/modification of the treatment was required in 13 of 45 (29%) and 11 of 39 (28%) patients of groups I and II, respectively. A total of 9 serious adverse events were documented; none of the patients died during the trial. Conclusions: Twenty‐six weeks likely represent the safe duration of combined IFX/immunomodulatory therapy in our sample of pediatric patients with CD.