Accelerated Step-Up Infliximab Use Is Associated with Sustained Primary Response in Pediatric Crohn’s Disease

J. Ling, D. Buurman, M. Ravikumara, C. Mews, K. Thacker, Z. Grover

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Earlier introduction of infliximab (IFX) in Crohn’s disease (CD) may be associated with a sustained remission. Methods and Aims: Children on scheduled IFX therapy for predominant luminal CD after successful induction (drop in PCDAI by ≥ 15) and a minimum of 2-year IFX follow-up were included. We compared outcomes of children treated with early (within 3 months from diagnosis) versus later IFX (after failing conventional therapy ≥ 3 months) and identify clinical predictors of sustained primary response (SPR) in our cohort. SPR was defined as CS-free clinical remission without requiring IFX dose escalation and/or surgical excision and/or switch to second anti-TNFs due to LOR or allergic reaction. Results: Sixty-four children received IFX therapy for CD during the study period. Forty-three children on scheduled IFX therapy for luminal CD met the inclusion criteria. During the median follow-up of 3.05 years (IQR 2.6–3.5 years), SPR was observed in 17/43 (40%). SPR was associated with shorter time from diagnosis to the initiation of IFX (5.4 vs. 18.7 months, p = 0.006). Binary logistic regression using multiple variables also confirmed that only early use of IFX is associated with SPR. Conclusion: Early step-up use of IFX in children with CD with inadequate clinical response to conventional therapies leads to sustained primary response over 2 years.

Original languageEnglish
Pages (from-to)1003-1010
Number of pages8
JournalDigestive Diseases and Sciences
Volume63
Issue number4
DOIs
Publication statusPublished - 1 Apr 2018

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