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Long-Term Durability of Infliximab for Pediatric Ulcerative Colitis: A Retrospective Data Review in a Tertiary

Hirotaka Shimizu1,2, Katsuhiro Arai1, Ichiro Takeuchi1,2

  • 1Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan.

Pediatric Gastroenterology, Hepatology & Nutrition
|January 28, 2021
PubMed

Insights

Infliximab (IFX) shows effectiveness in pediatric ulcerative colitis (UC), but long-term treatment success is limited. Many children discontinue IFX due to nonresponse, loss of response, or side effects, highlighting the need for careful patient selection and monitoring.

Area of Science:

  • Pediatric Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Long-term efficacy and safety of infliximab (IFX) in pediatric ulcerative colitis (UC) require further evaluation.
  • Understanding IFX durability is crucial for managing this chronic condition in children.

Purpose of the Study:

  • To assess the long-term efficacy, safety, and durability of infliximab (IFX) in a pediatric cohort with ulcerative colitis (UC).

Main Methods:

  • Retrospective analysis of 20 children with UC treated with infliximab (IFX).
  • IFX administered for induction (weeks 0, 2, 6) and maintenance (every 8 weeks), with dose adjustments based on clinical decisions.

Main Results:

  • Corticosteroid (CS)-free remission without dose escalation (DE) achieved in 30% at week 30 and 25% at week 54.
  • Patients achieving remission at week 30 sustained colectomy-free IFX treatment.
  • One-third discontinued IFX due to primary nonresponse, one-third due to secondary loss of response (sLOR).
  • Higher IFX durability observed with concurrent azathioprine use for over 6 months.
  • Infusion reactions (IRs) occurred in 10 patients, leading to discontinuation in four.
  • Psoriasis-like lesions developed in three patients; one experienced acute focal bacterial nephritis.

Conclusions:

  • Infliximab (IFX) is a relatively safe and effective option for pediatric ulcerative colitis (UC).
  • Achieving clinical remission by week 30 predicts long-term, colectomy-free IFX treatment.
  • Approximately two-thirds of patients faced challenges with IFX therapy, including nonresponse, sLOR, infusion reactions, and side effects.
Abstract

Keywords:
ChildDose escalationInfliximabRemissionUlcerative colitis

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