Abstract
Secondary loss of response (LoR) often precludes further use of infliximab in children with Crohn’s disease. Immunomodulators may reduce the incidence of LoR but their combination with infliximab presents safety concerns. We aimed to determine the long-term durability of infliximab response in paediatric Crohn’s, effect of immunomodulators on LoR, and secondarily the effect of infliximab on growth. We retrospectively audited patients on maintenance infliximab at a single centre. Data included height and weight, Paediatric Crohn’s Disease Activity Index (PCDAI), and immunomodulator use. 71 children (32% female, mean age 14.4 years) had been commenced on maintenance infliximab before July 2011. 89% had been on immunomodulators concurrently with infliximab. LoR occurred in 20 (28%), with a median time to LoR of 4.31 years. LoR was significantly increased in children who did not enter remission (PCDAI ≤ 10) after induction (p < 0.05). LoR occurred more frequently in the 72% who ceased immunomodulators, but this failed to reach statistical significance (p = 0.300). Height and weight SDS improved significantly on infliximab. Infliximab is a durable long-term therapy for paediatric Crohn’s refractory to conventional therapy. A large-magnitude increase in the rate of loss of response after immunomodulator cessation was not observed.
Highlights
A growing number of children suffer from refractory Crohn’s disease, requiring the use of biological drugs such as infliximab
We identified 109 patients who had received infliximab in the period from 2 November 2004 until
The availability of biological agents such as infliximab has transformed the care of patients with
Summary
A growing number of children suffer from refractory Crohn’s disease, requiring the use of biological drugs such as infliximab. Biological therapies provide both risks and benefits. Remission may be maintained for long periods on this therapy, but loss of response may occur, leaving children with few other options for a lifetime of disease [3]. There is some uncertainty regarding the incidence of loss of response: clinical trial evidence reports a rate of up to 36% within one year [4], whereas observational evidence suggests a lower incidence, with up to 67% of children continuing infliximab for more than three years [5]
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