Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 21, 2012; 18(11): 1229-1234
Published online Mar 21, 2012. doi: 10.3748/wjg.v18.i11.1229
High-dose infliximab for treatment of pediatric ulcerative colitis: A survey of clinical practice
Roy Nattiv, Janet M Wojcicki, Elizabeth A Garnett, Neera Gupta, Melvin B Heyman
Roy Nattiv, Janet M Wojcicki, Elizabeth A Garnett, Neera Gupta, Melvin B Heyman, Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California, San Francisco, CA 94143-0136, United States
Author contributions: All authors contributed equally to this work; Nattiv R, Wojcicki JM, Garnett EA and Heyman MB designed the research; Nattiv R, Wojcicki JM, Garnett EA and Heyman MB performed the research; Nattiv R, Wojcicki JM, Garnett EA, Gupta N and Heyman MB contributed to the analysis; Nattiv R, Wojcicki JM, Garnett EA, Gupta N and Heyman MB wrote the paper.
Supported by DK060617 (MBH); DK080825 (JMW); DK077734 (NG); CCFA Career Development Award (NG); and NIH/NCRR UCSF-CTSI Grant, No. UL1 RR024131
Correspondence to: Melvin B Heyman, MD, MPH, Professor, Anita Ow Wing Endowed Chair, Department of Pediatrics, UCSF Benioff Children’s Hospital, 500 Parnassus Ave, MU 4 East, Box 0136, University of California, San Francisco, CA 94143-0136, United States. mheyman@peds.ucsf.edu
Telephone: +1-415-4760820 Fax: +1-415-4761343
Received: April 14, 2011
Revised: July 11, 2011
Accepted: July 18, 2011
Published online: March 21, 2012
Abstract

AIM: To assess attitudes and trends regarding the use of high-dose infliximab among pediatric gastroenterologists for treatment of pediatric ulcerative colitis (UC).

METHODS: A 19-item survey was distributed to subscribers of the pediatric gastroenterology (PEDSGI) listserv. Responses were submitted anonymously and results compiled in a secure website.

RESULTS: A total of 113 subscribers (88% based in the United States) responded (101 pediatric gastroenterology attendings and 12 pediatric gastroenterology fellows). There were 46% in academic medical institutions and 39% in hospital-based practices. The majority (91%) were treating >10 patients with UC; 13% were treating >100 patients with UC; 91% had prescribed infliximab (IFX) 5 mg/kg for UC; 72% had prescribed IFX 10 mg/kg for UC. Using a 5-point Likert scale, factors that influenced the decision not to increase IFX dosing in patients with UC included: “improvement on initial dose of IFX” (mean: 3.88) and “decision to move to colectomy” (3.69). Lowest mean Likert scores were: “lack of guidelines or literature regarding increased IFX dosing” (1.96) and “insurance authorization or other insurance issues” (2.34). “Insurance authorization or other insurance issues” was identified by 39% as at least somewhat of a factor (Likert score ≥ 3) in their decision not to increase the IFX dose. IFX 10 mg/kg was more commonly used for the treatment of pediatric UC among responders based in the United States (75/100) compared to non-United States responders (6/13, P = 0.047). Induction of remission was reported by 78% of all responders and 81% reported maintenance of remission with IFX 10 mg/kg. One responder reported one death with IFX 10 mg/kg.

CONCLUSION: IFX 10 mg/kg is more commonly used in the United States to treat pediatric UC. Efficacy and safety data are required to avoid insurance barriers for its use.

Keywords: Immunosuppression; Inflammatory bowel disease; Ulcerative colitis; Children; Pharmacology