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Concomitant Therapy with Immunomodulator Enhances Infliximab Durability in Pediatric Inflammatory Bowel Disease

Cheng, Julianna MD, FRCP(C)*; Hamilton, Zachary BSc*; Smyth, Matthew BSc*; Barker, Collin MD, FRCP(C)*; Israel, David MD, FRCP(C)*; Jacobson, Kevan MBBCH, FRCP(C), FACP, AGAF*,†,‡

doi: 10.1097/MIB.0000000000001212
Original Clincial Article

Background: Data on long-term durability of infliximab (IFX) and outcomes of concomitant therapy with immunomodulator in pediatric inflammatory bowel disease are limited.

Methods: Children with inflammatory bowel disease who received IFX ± immunomodulator were retrospectively reviewed. Predictors of induction response were assessed using a binary logistic regression model and long-term outcomes evaluated by Cox proportional hazards model. Propensity score matching examined long-term efficacy of concomitant therapy in patients with Crohn's disease (CD).

Results: Among 148 patients (113 CD, 35 ulcerative colitis; median age at IFX initiation 14.09 years [interquartile range 12.16–15.65]), 91% experienced response to induction therapy; patients with CD were more likely to respond (95% versus 77%, odds ratio = 2.63, 95% confidence interval, 1.01–6.85, P = 0.048). Despite dose optimization, secondary loss of response occurred at a rate of 9.01% and 8.33% per year for patients with CD and ulcerative colitis, respectively. A Cox proportional hazards model showed that concomitant therapy >6 months significantly lowered the risk of secondary loss of response in CD (hazard ratio = 0.39, 95% confidence interval, 0.17–0.88, P = 0.025). The same trend was observed in ulcerative colitis but did not reach significance. A higher proportion of patients on IFX monotherapy stopped IFX because of loss of response or infusion reactions (55% versus 21%, P < 0.001). Propensity score analysis of patients with CD showed significantly higher steroid-free remission rates for concomitant versus monotherapy at 1 year (78% versus 54%, P = 0.020) and 2 years (68% versus 46%, P = 0.044), and durability of response (P = 0.022).

Conclusions: These data demonstrate sustained efficacy of IFX in a cohort of pediatric patients with inflammatory bowel disease with durability of response enhanced by concomitant therapy.

Supplemental Digital Content is Available in the Text.Article first published online 22 August 2017.

*Division of Gastroenterology, B.C. Children's Hospital, Vancouver, British Columbia, Canada;

Children and Family Research Institute, Vancouver, British Columbia, Canada; and

Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

Address correspondence to: Kevan Jacobson, MBBCH, FRCP(C), FACP, AGAF, Division of Gastroenterology, B.C. Children's Hospital, 4480 Oak Street, Room K4-181, Vancouver, British Columbia, Canada V6H 3V4 (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

KJ has received scientific advisory board fees from AbbVie, Janssen, and Ferring; and speaker fees from AbbVie and Janssen. The other authors have no conflict of interest to disclose.

J. Cheng and Z. Hamilton contributed equally to this work.

Received January 30, 2017

Accepted April 27, 2017

© Crohn's & Colitis Foundation
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