Modificação do tratamento com infliximab na doença de Crohn: experiência de um centro

Abstract

IntroductionTreatment of Crohn disease in pediatric patients must ensure not only symptom control but also remission, allowing normal growth and development. Infliximab has been shown to be effective in controlling disease in children and adolescents unresponsive to first-line treatment, although 30 to 55% of failure occurs, requiring therapeutic adjustments. Recent pediatric studies have shown that the efficacy of reducing the range from 8 to 6/7 weeks, increasing the dose to 10mg/kg dose or shortening the interval up to 4 weeks is similar. Objective and methodsRetrospective descriptive study of pediatric patients who were diagnosed with Crohn Disease and had infliximab treatment in last five years, with evaluation of treatment failure situations. ResultsWe included 16 patients (10 males, 6 females) treated with infliximab induction regimen, followed by 5mg/kg every 8 weeks. In most patients, treatment was initiated 10 months after diagnosis. In 50% there was clinical and/or analytical relapse, on average after 10 cycles of treatment (median 6.5), leading to an adjustment of the therapeutic regimen: 6 shortened the interval to 6/7 weeks, 1 shortened the interval to 4 weeks and 1 increased the dose to 10mg/kg. Of the 6 patients with 5mg/kg dose and interval of 6/7 weeks, all had initial favorable response but 4 required an increase of the dose to 10mg/kg, 2 of them are in remission. The disease remission with infliximab was 81.2%. DiscussionTreatment with infliximab was effective in controlling Crohn disease and in reducing the need of steroids, but dose adjustments were necessary, often occurring in the first year of treatment. Clinical changes determined the need of dose or interval increases or reductions. The predictable need to adjust treatment after a few months of treatment justifies that the choice of biologic therapy in Crohn disease has to be carefully considered after failure of other options.