Efficacy and tolerance of infliximab in children and adolescents with Crohn's disease.

Abstract

Infliximab, a monoclonal antibody against tumor necrosis factor-alpha, has been shown to be effective for the treatment of refractory Crohn's disease in adult patients, but experience in pediatrics is limited. This retrospective study included 88 children and adolescents, 39 girls and 49 boys, with a median age of 14 years (range 3.3-17.9). Infliximab was indicated for active disease (66%) and/or fistulas (42%) that were refractory to corticosteroids (70%), and/or other immunosuppressive (82%) agents, and/or parenteral nutrition (20%). Patients received 1 to 17 infusions (median 4) of 5 mg/kg (range 3.8-7.3) of infliximab during a median time period of 4 months (1-17 months). Infusion reaction was noted in 13 patients (15%), with a total of 16 reactions in 450 infusions (4%). At Day 90 after the first infusion of infliximab, symptoms improved in 49% of patients, whereas 29% of patients were in remission and 13% of patients relapsed. From Day 0 to Day 90, Harvey-Bradshaw score decreased from 7.5 to 2.8 (P < 0.001), C-reactive protein from 36 to 16 mg/L (P < 0.01), and 1-hour erythrocyte sedimentation rate from 35 to 17 mm (P < 0.01). Dosage of corticosteroids decreased from to 0.59 to 0.17 mg/kg/d (P < 0.001); 53% of patients could be weaned of corticosteroids and 92% of parenteral nutrition. Treatment with infliximab is well tolerated and effective in most children and adolescents with Crohn's disease that is refractory to conventional immunosuppressive therapy. Nevertheless, long-term efficacy remains to be shown, and further studies are urgently needed to precisely determine the best modality of continuing treatment.

• Authors: Thierry Lamireau, Jean-Pierre Cézard, Alain Dabadie, Olivier Goulet, Alain Lachaux, Dominique Turck, Chantal Maurage, Alain Morali, Etienne Sokal, Dominique Belli, Joaquim Stoller, Samy Cadranel, Jean-Louis Ginies, Sheila Viola, Frédéric Huet, Jane Languepin, Catherine Lenaerts, Françoise Bury, Jacques Sarles, French-Speaking Group for Pediatric Gastroenterology Nutrition
• Journal: Inflammatory bowel diseases (Inflamm Bowel Dis) Vol. 10 Issue 6 Pg. 745-50 (Nov 2004) ISSN: 1078-0998 [Print] England
• PMID: 15626892 (Publication Type: Evaluation Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Gastrointestinal Agents
• Tumor Necrosis Factor-alpha
• Infliximab

Topics

• Adolescent
• Antibodies, Monoclonal (administration & dosage, adverse effects, therapeutic use)
• Child
• Child, Preschool
• Crohn Disease (drug therapy, pathology)
• Europe
• Female
• Gastrointestinal Agents (administration & dosage, adverse effects, therapeutic use)
• Humans
• Infant
• Infliximab
• Infusions, Intravenous
• Male
• Medical Records
• Retrospective Studies
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)