The duration of effect of infliximab maintenance treatment in paediatric Crohn's disease is limited
C I De Bie, T Z Hummel, A Kindermann, F T M Kokke, G M Damen, C M F Kneepkens, P F Van Rheenen, J J Schweizer, J H Hoekstra, O F Norbruis, W E Tjon A Ten, A C Vreugdenhil, J M Deckers-Kocken, C F M Gijsbers, J C Escher, L De Ridder, C I De Bie, T Z Hummel, A Kindermann, F T M Kokke, G M Damen, C M F Kneepkens, P F Van Rheenen, J J Schweizer, J H Hoekstra, O F Norbruis, W E Tjon A Ten, A C Vreugdenhil, J M Deckers-Kocken, C F M Gijsbers, J C Escher, L De Ridder
Abstract
Background: Infliximab is effective for induction and maintenance of remission in children with moderately to severely active Crohn's disease (CD).
Aim: To evaluate the long-term efficacy of infliximab treatment in paediatric CD.
Methods: In this observational, multicentre study, all paediatric CD patients in The Netherlands treated with infliximab from October 1992 to November 2009 and with minimal follow-up of 3 months since start of infliximab, were studied.
Results: One hundred and fifty-two CD patients [81M; median age at start of infliximab 15.0 years (IQR 13.1-16.4)] received a median number of 10.5 infliximab infusions (IQR 6-21). Median follow-up after start of infliximab was 25 months (IQR 13-40). Kaplan-Meier analysis showed that the cumulative probability of losing response to infliximab in patients who initially required repeated infusions was 13%, 40% and 50% after 1, 3 and 5 years, respectively. Seventy-four patients (49%) needed dose adjustments, with a median time to any adjustment of 6 months.
Conclusions: Duration of effect of infliximab is limited as 50% of patients on infliximab maintenance treatment lose their therapeutic response after 5 years. Dose adjustments after start of infliximab are frequently needed to regain therapeutic benefit. These findings emphasise the need for effective, long-term treatment strategies for paediatric CD.
© 2010 Blackwell Publishing Ltd.
Source: PubMed