COMPARABLE CLINICAL OUTCOMES IN PEDIATRIC PATIENTS WITH CROHN’S DISEASE TREATED WITH ACCELERATED VS. STANDARD INFLIXIMAB DOSING DURING INDUCTION

Abstract

Abstract BACKGROUND Accelerated infliximab administration during induction is used extensively in pediatric patients with Crohn’s disease (CD), though the overall effect of this approach on patients’ outcomes in several studies has been questionable. We aimed to assess in a real-life cohort whether accelerated infliximab administration during induction resulted in improved clinical outcomes in pediatric CD. METHODS This single-center retrospective study included patients aged<18 years diagnosed with CD between 2016-2021 that were treated with infliximab. We compared outcomes of patients treated with standard-dosing (0,2,6,14, up to 8mg/kg) vs. accelerated-dosing. Primary outcome with steroid-free clinical remission by week 52. RESULTS Sixty-eight patients were included, of whom 7 discontinued infliximab prior to week 14, due to infusion reactions or primary non-response resulting in surgery. 25 received standard-dosing, and 36 accelerated-dosing, including 19 patients that received >8mg/kg infliximab at 1st infusion. Comparison of both groups at time of infliximab initiation showed similar demographic features, Paris classification, prior rates of medication failure and rates of current immunomodulator use. Importantly, the baseline median pCDAI (23.0 [12.5-26.5] vs. 18.8 [13.1-26.9]), CRP (1.5 [0.3-5.5] vs. 1.4 [0.4-3.4] and calprotectin (782 [66-3840] vs. 1060 [576-2900]) values were comparable in the standard- and accelerated-dosing groups, respectively. Patients in the accelerated-dosing group achieved a higher trough infliximab level by end of induction (10.3±6.6 vs. 3.3±3.4, P<0.001), and more patients were above the target trough infliximab level (78.1% vs. 21.8%, P<0.001). However, the median PCDAI and inflammatory markers at week 14, 26 and 52 were comparable between groups. Moreover, the rates of patients above the desired trough levels were also comparable at week 52 (71.4% vs. 70.6% in the accelerated vs. standard-dosing group). Finally, rates of treatment discontinuation were also similar among groups. CONCLUSIONS In a retrospective cohort, accelerated infliximab dosing during induction didn’t result in improved clinical outcomes up to 52 weeks.