[Infliximab therapy for inflammatory bowel disease: seven years on]
O Segarra Cantón1, D Infante Pina, R Tormo Carnicé
1Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Materno-Infantil Vall d'Hebron, Barcelona, España. oscarsegarra@hotmail.com
Insights
Infliximab showed varying efficacy in pediatric inflammatory bowel disease, with good results in Crohn's disease but limited effectiveness in indeterminate colitis. Further pediatric studies are needed to confirm these findings.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Pharmacology
Context:
- Inflammatory bowel disease (IBD) presents significant challenges in pediatric populations.
- Infliximab, a biologic agent, has emerged as a treatment option for IBD.
- Understanding its efficacy and safety in children is crucial for clinical practice.
Purpose:
- To evaluate the clinical experience and efficacy of infliximab in pediatric patients with IBD at a single center.
- To analyze treatment outcomes based on specific IBD diagnoses (Crohn's disease, ulcerative colitis, indeterminate colitis).
Summary:
- Retrospective review of 14 pediatric IBD patients (9 Crohn's, 3 ulcerative colitis, 2 indeterminate colitis) treated with infliximab.
- Significant clinical remission achieved in Crohn's disease (80% at week 10) and ulcerative colitis (initially 100%, 33% long-term).
- Limited efficacy in indeterminate colitis; adverse events included infusion reactions and infections.
Impact:
- Infliximab demonstrates differential efficacy across pediatric IBD subtypes, being most effective in Crohn's disease.
- Findings highlight the need for further randomized controlled trials in pediatric IBD to establish optimal treatment strategies.
- The study contributes to the understanding of infliximab's role in managing pediatric IBD.
Introduction:
The aim of this study was to describe the clinical experience of our center of the use of infliximab in pediatric patients with inflammatory bowel disease.
Material And Methods:
We retrospectively reviewed all infliximab infusions administered in the Pediatric Gastroenterology Unit from October of 1999 to October of 2006. Fourteen patients (nine with Crohn's disease, three with ulcerative colitis, and two with indeterminate colitis) with a mean age of 9.6 years at diagnosis were treated with infliximab. Seventy-seven infusions were administered.
Results:
Efficacy was analyzed according to inflammatory bowel disease. Crohn's disease: in severe cases (PCDAI > 30), clinical remission (PCDAI < 10) was obtained in 80 % of the patients at week 10, decreasing to 60 % at week 54. Corticosteroid therapy could be reduced in 89 % of the patients and was discontinued in 55.5 %. Ulcerative colitis: clinical remission (modified Truelove-Witts index < 10) was initially obtained in 100 % of the patients but only 33 % were still in clinical remission at the end of the study. In the two corticosteroid-dependent patients, corticosteroid therapy could be reduced and even discontinued in one (50 %). Indeterminate colitis: neither of the two patients achieved clinical remission. The most frequent adverse effects observed were acute infusional reactions (42.8 % of the patients and 10.3 % of infusions), one of which was severe, and infections (28.6 % of patients), one of which (ileal abscess) required surgery.
Conclusions:
The efficacy of infliximab seems to differ considerably in the distinct types of inflammatory bowel disease and is practically null in indeterminate colitis. Randomized controlled studies in children are required to assess the exact efficacy of infliximab in our patients.
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