Infliximab induces and maintains clinical remission in children with Crohn's disease (CD), but specifically pediatric long-term data remain sparse.
Dr Peter Church and colleagues reviewed patients who received infliximab ± immunomodulator for luminal Crohn's disease.
Outcomes included clinical response, linear growth, and mucosal healing.
Durability of response was assessed using Cox proportional hazards models.
Levels of infliximab and antibodies (antibodies to infliximab) were measured when response was lost.
The team found that among 195 patients, 81% experienced complete response.
Longer duration of diagnosed Crohn's disease and female gender were associated with lower response.
|16/157 complete responders experienced loss of response at a rate of 2% to 6% per year |
|Inflammatory Bowel Diseases|
The team observed that during first year of follow-up, 35% of subjects had regimen individualized through dose escalation/interval shortening.
Despite regimen optimization, 16/157 complete responders experienced loss of response at a rate of 2% to 6% per year over 5 years, associated with development of antibodies to infliximab.
The researchers found that concurrent immunomodulation for ≥30 weeks significantly decreased loss of response.
Follow-up endoscopic examination was performed in 40 responders, of whom 73% demonstrated complete resolution of mucosal ulceration.
Patients with growth potential demonstrated significant improvements in mean height z-score from induction to years 1 and 2 of follow-up.
With infliximab initiation within the first 18 months after diagnosis, mean height z-score normalized to 0 after 3 years.
Dr Church's team concludes, "These data demonstrate sustained effectiveness of infliximab in children and adolescents with luminal Crohn's disease."
"Durability of response is increased by concomitant immunomodulation."
"Clinical response is associated with enhanced linear growth, particularly when therapy is initiated early."