Long-term outcome of infliximab therapy in pediatric Crohn disease

• Published in: Archives de pédiatrie : organe officiel de la Société française de pédiatrie Vol. 18; no. 8; pp. 863 - 869
• Main Authors: Wanty, C, Stephenne, X, Sokal, E, Smets, F
• Format: Journal Article
• Language: French
• Published: France 01.08.2011
• Subjects: Adolescent; Anti-Inflammatory Agents - therapeutic use; Antibodies, Monoclonal - therapeutic use; Child; Crohn Disease - drug therapy; Female; Humans; Infliximab; Male; Retrospective Studies; Time Factors; Treatment Outcome
• ISSN: 1769-664X
• DOI: 10.1016/j.arcped.2011.05.022

The efficacy of infliximab (IFX) in inducing and maintaining remission in pediatric Crohn disease is currently well documented. However, the optimal treatment strategy beyond 1 year has not been established. In particular, systematic continuation of maintenance therapy and its association with immunomodulators have not yet been analyzed. The aim of this study was to describe the long-term outcome of pediatric Crohn disease patients on IFX therapy and to evaluate the clinical response to the therapy and the effect on growth. A single-center and retrospective chart review was conducted. The clinical maintenance response to treatment, effect on the linear growth, and long-term outcome were examined. These parameters were analyzed according to the age of the patients, duration and localization of the disease, as well as associated therapies. We identified 52 children with Crohn disease younger than 16 years of age at the time of diagnosis. Of these patients, 20 (38%) received a biologic therapy at a mean age of 13.9±2 years. Fifteen patients received IFX therapy and 13 (86%) were in clinical remission 10 weeks after the first infusion. Among the responders, 82% were still in remission after 1 year of therapy and 66% after 2 years. Among patients treated for more than 1 year, we observed IFX dependency in 89%. Thirty-eight percent of patients with initial IFX response showed a loss of response after a median of 30 months (range, 3-42 months). At 2 years, the median Z score for height among patients with presumed growth potential had improved slightly, from -0.7 to -0.55 DS. No serious adverse events were observed. Our results confirm the continuous efficacy of IFX in pediatric Crohn disease patients after 1 year of treatment. However, a high level of dependency was observed (89 %). A slight beneficial effect on growth was observed after 2 years of treatment.