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Accelerated Step-Up Infliximab Use Is Associated with Sustained Primary Response in Pediatric Crohn’s Disease

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Abstract

Background

Earlier introduction of infliximab (IFX) in Crohn’s disease (CD) may be associated with a sustained remission.

Methods and Aims

Children on scheduled IFX therapy for predominant luminal CD after successful induction (drop in PCDAI by ≥ 15) and a minimum of 2-year IFX follow-up were included. We compared outcomes of children treated with early (within 3 months from diagnosis) versus later IFX (after failing conventional therapy ≥ 3 months) and identify clinical predictors of sustained primary response (SPR) in our cohort. SPR was defined as CS-free clinical remission without requiring IFX dose escalation and/or surgical excision and/or switch to second anti-TNFs due to LOR or allergic reaction.

Results

Sixty-four children received IFX therapy for CD during the study period. Forty-three children on scheduled IFX therapy for luminal CD met the inclusion criteria. During the median follow-up of 3.05 years (IQR 2.6–3.5 years), SPR was observed in 17/43 (40%). SPR was associated with shorter time from diagnosis to the initiation of IFX (5.4 vs. 18.7 months, p = 0.006). Binary logistic regression using multiple variables also confirmed that only early use of IFX is associated with SPR.

Conclusion

Early step-up use of IFX in children with CD with inadequate clinical response to conventional therapies leads to sustained primary response over 2 years.

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Authors and Affiliations

  1. Medical School, University of Western Australia, Crawley, WA, Australia

    J. Ling & D. Buurman

  2. Gastroenterology Department, Princess Margaret Hospital for Children, Perth, WA, Australia

    M. Ravikumara, C. Mews, K. Thacker & Z. Grover

  3. Queensland Children’s Medical Research Institute, Brisbane, QLD, Australia

    Z. Grover

Authors
  1. J. Ling
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  2. D. Buurman
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  3. M. Ravikumara
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  4. C. Mews
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  5. K. Thacker
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  6. Z. Grover
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Corresponding author

Correspondence to Z. Grover.

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The authors declare that they have no conflicting interest and have not received any funding for this study.

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Ling, J., Buurman, D., Ravikumara, M. et al. Accelerated Step-Up Infliximab Use Is Associated with Sustained Primary Response in Pediatric Crohn’s Disease. Dig Dis Sci 63, 1003–1010 (2018). https://doi.org/10.1007/s10620-018-4969-8

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  • DOI: https://doi.org/10.1007/s10620-018-4969-8

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