We examined short- and long-term benefits and safety of infliximab (IFX) in a population-based cohort of Crohn's disease (CD) patients <17 years old at diagnosis.
The following parameters were assessed: short- and long-term efficacy of IFX, impact of drug efficacy, and mode of administration on rate of resection surgery, growth and nutritional catch-up, and adverse events (AEs).
In all, 120 patients (69 female) required IFX with a median duration of 32 months (Q1 = 8–Q3 = 60). Median age at diagnosis was 14.5 years (12–16) and median interval between diagnosis and IFX initiation was 41 months (22–78). Median follow-up since CD diagnosis was 111 months (75–161). Fifty patients (42%) received episodic and 70 (58%) maintenance therapy. Sixty-five (54%) patients were in the “IFX efficacy” group: 38 (32%) still receiving IFX at the last visit and 27 (22%) stopping IFX while in remission. The “IFX failure” group included 55 (46%) patients: 17 (14%) who stopped IFX due to AEs and 38 (32%) nonresponders. The risk of surgery was reduced (P = 0.009) in the “IFX efficacy” group and lower (P = 0.03) in patients with scheduled versus episodic therapy. Patients in the “IFX efficacy” group had significant catch-up growth (P = 0.04), while those in the “IFX failure” group did not. Twenty-four patients presented AEs leading to cessation of IFX in 17 of them.
In this population-based cohort of pediatric-onset CD, IFX treatment was effective in more than half of patients during a median follow-up of 32 months. Long-term IFX responders had a lower rate of surgery and improved catch-up in growth, especially when receiving scheduled IFX therapy. (Inflamm Bowel Dis 2011;)
1Gastroenterology Unit, EPIMAD Registry, Lille University Hospital, Lille, France, 2Biostatistics Unit, Lille University Hospital, Lille, France, 3Gastroenterology Unit, EPIMAD Registry, Rouen University Hospital, Rouen, France, 4Gastroenterology Unit, EPIMAD Registry, Amiens Hospital and University, Amiens, France, 5Epidemiology Unit, EPIMAD Registry, Rouen University Hospital, Rouen, France, 6Pediatric Unit, EPIMAD Registry, Lille University Hospital, Lille, France, 7Epidemiology Unit, EPIMAD Registry, Lille University Hospital, Lille, France and 8Gastroenterology Unit, St Louis Hospital, Paris, France.
Department of Hepato- Gastroenterology and Registre EPIMAD, Hôpital Claude Huriez, CH et U de Lille, 59037 Lille Cedex, France
Received 18 November 2010; Accepted 28 November 2010
Published online 1 February 2011 in Wiley Online Library (wileyonlinelibrary.com).