Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Apr 14, 2010; 16(14): 1776-1781
Published online Apr 14, 2010. doi: 10.3748/wjg.v16.i14.1776
Efficacy of early treatment with infliximab in pediatric Crohn’s disease
Jong Seung Lee, Jee Hyun Lee, Ji Hyuk Lee, Hye Jin Lee, Mi Jin Kim, Hae Jeong Lee, Yon Ho Choe
Jong Seung Lee, Department of Pediatrics, College of Medicine, Chung-Ang University Yongsan Hospital, Yongsan, Seoul 140-757, South Korea
Jee Hyun Lee, Ji Hyuk Lee, Hye Jin Lee, Mi Jin Kim, Hae Jeong Lee, Yon Ho Choe, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam, Seoul 135-710, South Korea
Author contributions: Lee JS and Choe YH designed the study and wrote the manuscript; Lee JS, Lee JH, Lee JH, Lee HJ, Kim MJ and Lee HJ contributed equally to this study and analyzed the data.
Correspondence to: Yon Ho Choe, MD, PhD, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam, Seoul 135-710, South Korea. i101016@skku.edu
Telephone: +82-2-34103539 Fax: +82-2-34100043
Received: December 18, 2009
Revised: January 25, 2010
Accepted: February 1, 2010
Published online: April 14, 2010
Abstract

AIM: To investigate the effectiveness of early infliximab use for induction and maintenance therapy in pediatric Crohn’s disease.

METHODS: We performed a retrospective chart review of 36 patients with Crohn’s disease. Ten patients (group A) were treated with mesalamine after induction therapy with oral prednisolone, and 13 patients (group B) were treated with azathioprine after induction therapy with oral prednisolone. Thirteen patients (group C) received infliximab and azathioprine for induction and maintenance therapy for the first year, and were treated with azathioprine after 1 year. All patients were followed for at least 24 mo. Efficacy was determined by the relapse rate using the pediatric Crohn’s disease activity index score in each group at 12 and 24 mo.

RESULTS: At the 1 year follow-up, the relapse rate (23.1%, 3 of 13 patients) in group C was lower than that (61.5%, 8 of 13 patients) in group B (P = 0.047). At the 2 years follow-up, the relapse rate (38.5%, 5 of 13 patients) in group C was lower than that (76.9%, 10 of 13 patients) in group B (P = 0.047). Adverse events in group C were fewer than in groups A and B.

CONCLUSION: Early induction with infliximab at diagnosis, known as “top-down” therapy, was effective for reducing the relapse rate compared to conventional therapies for at least 2 years.

Keywords: Efficacy; Infliximab; Pediatric Crohn’s disease; Relapse rate; Top-down treatment