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Predictors of Long-term Clinical and Endoscopic Remission in Children With Crohn Disease Treated With Infliximab

D’Arcangelo, Giulia; Oliva, Salvatore; Dilillo, Anna; Viola, Franca; Civitelli, Fortunata; Isoldi, Sara; Cucchiara, Salvatore; Aloi, Marina

Journal of Pediatric Gastroenterology and Nutrition: June 2019 - Volume 68 - Issue 6 - p 841–846
doi: 10.1097/MPG.0000000000002262
Original Articles: Gastroenterology: Inflammatory Bowel Disease

Objectives: We aimed to identify early noninvasive predictors of clinical and endoscopic remission in children with Crohn disease (CD) under infliximab (IFX).

Methods: Prospective observational study conducted in children with moderate-to-severe CD starting IFX. All patients underwent weighted pediatric CD activity index (wPCDAI) assessment, C-reactive protein and fecal calprotectin (FC) at week 0, 14, and 48. Endoscopy was performed at 0 and 48 weeks. The primary outcome was to determine the ability of 14-week wPCDAI, C-reactive protein, and FC to predict 1-year steroid-free clinical remission and mucosal healing. As a secondary outcome we evaluated their concordance with Simple Endoscopic Score for CD (SES-CD) at week 48.

Results: Forty-one children were enrolled. At 1 year, 21 (51%) and 16 (39%) were in clinical and endoscopic remission. Only combined postinduction FC and wPCDAI were able to predict 1-year clinical and endoscopic remission (hazard ratio 4.81 [95% confidence interval 1.76–20.45], P = 0.05 and hazard ratio 5.51 [95% confidence interval 1.83–26.9], P = 0.03). One-year SES-CD moderately correlated with FC (r = 0.52; P = 0.001). The FC cut-off value for mucosal healing was 120.5 μg/g (area under the curve 0.863, 83% sensitivity, 75.5% specificity; P = 0.005). The concordance between wPCDAI and SES-CD was excellent and good for severe disease and remission (k 0.87 and 0.76).

Conclusions: Post induction FC combined with wPCDAI can predict 1-year clinical and endoscopic response to IFX in pediatric CD. FC shows a moderate correlation with SES-CD, whereas wPCDAI has a good concordance with endoscopic remission or severe disease, but not with mild and moderate disease.

Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.

Address correspondence and reprint requests to Marina Aloi, MD, PhD, Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161 Roma, Italy (e-mail:

Received 26 April, 2018

Accepted 7 December, 2018

All the authors declare no financial relationships with a commercial entity producing health-related products and or services related to this article. No honorarium, grant, or other form of payment was given to anyone to write and to produce the manuscript.

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The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,