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Accelerated Step-Up Infliximab Use Is Associated with Sustained Primary Response in Pediatric Crohn's Disease
J Ling1, D Buurman1, M Ravikumara2
1Medical School, University of Western Australia, Crawley, WA, Australia.
Insights
Early infliximab (IFX) treatment in pediatric Crohn's disease (CD) significantly improves sustained remission rates. Initiating IFX within three months of diagnosis is linked to better long-term outcomes in children with CD.
Area of Science:
- Pediatric gastroenterology
- Immunomodulatory therapies
- Inflammatory bowel disease research
Background:
- Crohn's disease (CD) management in children often involves complex treatment strategies.
- The timing of infliximab (IFX) initiation may impact long-term remission in pediatric CD.
- Understanding predictors of sustained response is crucial for optimizing therapy.
Purpose of the Study:
- To evaluate the association between early versus late infliximab (IFX) initiation and sustained primary response (SPR) in pediatric Crohn's disease (CD).
- To identify clinical predictors of SPR in children with CD receiving scheduled IFX therapy.
- To assess outcomes in children with CD treated with IFX after a minimum of 2-year follow-up.
Main Methods:
- Retrospective analysis of pediatric patients with luminal CD on scheduled IFX therapy.
- Inclusion criteria: successful induction therapy (PCDAI drop ≥15) and ≥2-year IFX follow-up.
- Comparison of outcomes between early (≤3 months from diagnosis) and late (>3 months from diagnosis) IFX initiation.
Main Results:
- Forty-three pediatric CD patients met inclusion criteria; 40% achieved sustained primary response (SPR) over a median 3.05-year follow-up.
- Early IFX initiation (median 5.4 months from diagnosis) was significantly associated with SPR compared to later initiation (median 18.7 months).
- Multivariable analysis confirmed early IFX use as the sole predictor of SPR.
Conclusions:
- Early step-up infliximab (IFX) therapy in children with Crohn's disease (CD) demonstrates a sustained primary response.
- Initiating IFX within three months of diagnosis is a key factor for achieving long-term remission in pediatric CD patients.
- This strategy offers a promising approach for managing pediatric CD.
Background:
Earlier introduction of infliximab (IFX) in Crohn's disease (CD) may be associated with a sustained remission.
Methods And Aims:
Children on scheduled IFX therapy for predominant luminal CD after successful induction (drop in PCDAI by ≥ 15) and a minimum of 2-year IFX follow-up were included. We compared outcomes of children treated with early (within 3 months from diagnosis) versus later IFX (after failing conventional therapy ≥ 3 months) and identify clinical predictors of sustained primary response (SPR) in our cohort. SPR was defined as CS-free clinical remission without requiring IFX dose escalation and/or surgical excision and/or switch to second anti-TNFs due to LOR or allergic reaction.
Results:
Sixty-four children received IFX therapy for CD during the study period. Forty-three children on scheduled IFX therapy for luminal CD met the inclusion criteria. During the median follow-up of 3.05 years (IQR 2.6-3.5 years), SPR was observed in 17/43 (40%). SPR was associated with shorter time from diagnosis to the initiation of IFX (5.4 vs. 18.7 months, p = 0.006). Binary logistic regression using multiple variables also confirmed that only early use of IFX is associated with SPR.
Conclusion:
Early step-up use of IFX in children with CD with inadequate clinical response to conventional therapies leads to sustained primary response over 2 years.