Infliximab: The Benefit for Refractory Crohn Disease andTop-down Induction Therapy in Severe Crohn Disease.
- Author:
Jee Hyun LEE
1
;
Hae Jeong LEE
;
Sung Eun PARK
;
Yon Ho CHOE
Author Information
1. Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. i101016@skku.edu
- Publication Type:Original Article
- Keywords:
Crohn disease;
Infliximab;
Children;
Top-down treatment
- MeSH:
Antibodies, Monoclonal;
Child;
Crohn Disease;
Fistula;
Follow-Up Studies;
Humans;
Immunologic Factors;
Remission Induction;
Serum Albumin;
Tumor Necrosis Factor-alpha;
Infliximab
- From:Korean Journal of Pediatric Gastroenterology and Nutrition
2008;11(1):28-35
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: The aim of this study is to report the efficacy of infliximab, a monoclonal antibody directed against tumor necrosis factor alpha which is used for both treatment of refractory pediatric Crohn disease (CD) and induction of remission. METHODS: Among pediatric patients who were diagnosed with CD at Samsung Medical Center between March 2001 and August 2007, a total of 16 patients were given infliximab to treat conventional therapy- resistant refractory CD and severe active CD for induction of remission. Patients needing maintenance therapy were treated with an infliximab infusion every 8 weeks, and fistulizing CD patients occasionally received the infusion upon the condition that a fistula developed. The efficacy of treatment was assessed by comparing the Pediatric Crohn Disease Activity Index (PCDAI), Hct, ESR, CRP, and serum albumin levels using paired t-test. RESULTS: The male/female ratio was 13:3, and the median age was 13 years (range, 21 months~15 years). The patients included 7 cases of therapy-resistant refractory CD, 7 cases of severe active CD, and 2 cases of fistulizing CD. Mean PCDAI before infliximab therapy was 34.19+/-14.96, and mean follow-up PCDAI within 2 to 4 weeks after the last infusion was significantly lower, at 6.88+/-10.31 (p= 0.000). Hematological markers such as ESR (p=0.000), serum albumin (p=0.016), and CRP (p=0.009) also improved significantly after infusion. Remission was achieved in 2 of 4 patients refractory to conventional therapy. Among 3 steroid-dependent patients, 2 were able to discontinue steroid therapy, and dose reduction was possible in 1 patient. Remission after top-down therapy without prior use of other immunomodulators was achieved in 6 weeks in all 7 of the patients who had severe CD. Nine of ten refractory fistulizing CD patients also showed improvement after infliximab therapy. CONCLUSION: Infliximab was effective in pediatric refractory CD for induction of remission and maintenance therapy, as well as in severe CD for top-down induction therapy. Furthermore, infliximab has contributed to steroid cessation and dose reduction. Long-term follow-up evaluation is needed to determine safety and efficacy of infliximab in the future.
