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Induction and maintenance infliximab therapy in children with moderate to severe ulcerative colitis: Retrospective,
Barbara M Iwańczak1, Jarosław Kierkuś2, Józef Ryżko2
12nd Department of Paediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Poland.
Insights
Infliximab therapy shows promise for pediatric ulcerative colitis (UC) patients experiencing severe relapses. This treatment can induce remission and potentially prevent the need for colectomy in some children.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Inflammatory Bowel Disease
Background:
- Pediatric ulcerative colitis (UC) is a severe gastrointestinal condition requiring effective treatment strategies.
- Current guidelines recommend corticosteroids for acute relapses, with biologics like infliximab considered for refractory cases.
Purpose of the Study:
- To retrospectively evaluate the efficacy and safety of infliximab in treating moderate-to-severe and severe pediatric UC relapses.
- Assessing infliximab's role in achieving clinical response and remission in young UC patients.
Main Methods:
- Analysis of 42 pediatric patients (aged 4-18) with moderate-to-severe UC over 4 years.
- Infliximab administered at 5 mg/kg during induction (weeks 0, 2, 6) and then every 8 weeks for maintenance up to 12 months.
- Disease activity assessed using the Pediatric Ulcerative Colitis Activity Index (PUCAI).
Main Results:
- Clinical response observed in 33.33% and clinical remission in 26.19% after induction therapy.
- Maintenance therapy sustained remission in 57.14% of patients.
- Two patients experienced anaphylactic shock; three required colectomy during the study period.
Conclusions:
- Infliximab therapy effectively induces remission in children with moderate-to-severe UC.
- Infliximab can be a valuable option for preventing early colectomy in pediatric UC patients.
Background:
Pediatric ulcerative colitis (UC) is a severe disease characterised by the presence of extensive inflammatory lesions in the colon. The administration of intravenous corticosteroids is recommended in patients with acute relapse of the disease, whereas early treatment with cyclosporine, tacrolimus or infliximab is recommended if there is no improvement.
Objectives:
The aim of this study was to retrospectively evaluate the efficacy and safety of infliximab therapy in the treatment of moderate-to-severe and severe relapse of pediatric UC.
Material And Methods:
The analysis included 42 children aged 4-18 years (23 girls, 19 boys) treated in 7 pediatric gastroenterology departments in Poland during the past 4 years. The disease duration ranged from 2 to 100 months. The clinical activity of UC ranged from 35 to 85 points according to the PUCAI scale. Twenty-one children were diagnosed with pancolitis, 10 children with extensive UC, and the remaining with the left-sided UC. In the induction therapy infliximab was administered at doses of 5 mg/kg in the 0.2 and 6 weeks, and after the clinical response every 8 weeks to 12 months. Treatment results were assessed in 10 and 54 weeks.
Results:
After the induction therapy the clinical response was achieved in 14 children (33.33%) and clinical remission in 11 children (26.19%). Two children required surgical treatment, and the remaining 2 suffered from anaphylactic shock. After the maintenance therapy clinical remission was maintained in 12 children (57.14%), whereas 3 children required surgery (colectomy).
Conclusions:
Infliximab therapy in children with moderate-to-severe UC induces remission and, in some children, proves to be effective in preventing early colectomy.