The Treatment of Pediatric Ulcerative Colitis with Infliximab, a Long-Term Evaluation

Abstract

Purpose: We evaluate the indications for infliximab to treat pediatric ulcerative colitis (UC) and report long-term follow-up. Methods: The charts of 27 pediatric patients with UC who were treated with infliximab were reviewed. All patients would have otherwise been candidates for colectomy. The acute group included patients with new onset UC refractory to IV steroids for 5–7 days and patients with non-steroid dependent UC with a fulminant exacerbation; the chronic group included patients with chronic steroid dependent UC. Lichtiger colitis activity index (LCAI) was measured for all patients at 0, 1, and 2 months after infliximab. Patients were regarded as successfully treated if they remained off steroids and avoided colectomy. Results: The acute and chronic groups included 16 and 11 patients respectively. The acute group had a mean LCAI score of 11.4 at induction and a mean net change of 11.1 after 2 months. The chronic group had a mean LCAI score of 11.2 and a mean change of 5.7. The acute group had a significantly greater net LCAI change than the chronic, p = 0.001. The net LCAI change in the patients treated successfully was not significantly different than those who failed, p = 0.43. The mean follow-up time from last infliximab was 13 months. Infliximab was successful in 75% of patients in the acute group and 27% in the chronic. Infliximab is no longer required in 80% of patients (83% of acute; 67% of chronic) who were successfully treated. These patients had a mean of 10 infusions and a mean follow-up of 10 months from last infliximab. Conclusions: (1) Infliximab appears to be effective for patients with acute UC refractory to IV steroids and non-steroid dependent UC with fulminant exacerbation. (2) Patients with steroid dependent UC respond poorly to infliximab. (3) Infliximab could be first line therapy for severe UC although further study is needed. 4) Patients successfully treated with infliximab can discontinue therapy and maintain their remission, possibly only needing the induction phase of infliximab therapy.