Predictors of response to Infliximab in children with luminal Crohn's disease |
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| Affiliation: | 1. Queensland Children Medical Research Institute, Brisbane, QLD, Australia;2. Queensland Paediatric Gastroenterology Hepatology, Royal Children''s Hospital, Brisbane, QLD, Australia;3. University Of Queensland, Department of Paediatrics & Child Health, Brisbane, QLD, Australia;1. Department of Gastroenterology and Hepatology, Academic Medical Center, The Netherlands;2. Department of Surgery, Academic Medical Center, The Netherlands;3. Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, The Netherlands;4. Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, The Netherlands;5. Department of Gastroenterology and Hepatology, St Lucas Andreas Hospital, The Netherlands;6. Department of Gastroenterology and Hepatology, Medical Centre Alkmaar, The Netherlands;7. Department of Gastroenterology and Hepatology, Free University Medical Centre, The Netherlands;1. Dept of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden;2. Dept of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden;3. Dept of Gastroenterology and Hepatology, Karolinska University Hospital and Dept of Clinical Science and Education, karolinska Institutet, Stockholm, Sweden;1. Hospital de la Santa Creu i Sant Pau (Barcelona), Universitat Autònoma de Barcelona, Catalonia, Spain;2. Hospital Universitari Germans Trias i Pujol (Badalona), CiberEHD, Catalonia, Spain;3. Hospital Universitari de Bellvitge, IDIBELL (L''Hospitalet de Llobregat), Catalonia, Spain;1. Gastroenterology Unit, S. Camillo-Forlanini Hospital, Rome, Italy;2. Gastroenterology & Hepatology Unit, S. Filippo Neri Hospital, Rome, Italy;3. IBD Unit, Columbus-Gemelli Hospital, Catholic University, Rome, Italy;4. Gastroenterology Division, AO Ordine Mauriziano, Turin, Italy;5. Department of Internal Medicine, “TorVergata” University, Rome, Italy;6. Gastroenterology Section, Di.Bi.Mis, University of Palermo, Palermo, Italy;7. Division of Gastroenterology, Dept. of Medical & Surgical Sciences, University Hospital Careggi, Florence, Italy;8. Gastroenterology Unit, University of Naples, Naples, Italy;9. Dept. of Internal Medicine, AO Villa Sofia-Cervello, Palermo, Italy;10. Gastroenterology Unit, Department of Internal Medicine and Public Health, University of L''Aquila, L''Aquila, Italy;11. Gastroenterology Unit, S. Giuseppe Hospital, Milan, Italy;1. Department of Histology, Medical University of Gdańsk, Gdańsk, Poland;2. Department of Gastroenterology and Hepatology, Medical University of Gdańsk, Gdańsk, Poland;3. Department of Endocrinology and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland;4. Department of Gastroenterology, Medical University of Lublin, Lublin, Poland;1. Department of Internal Medicine, Södra Älvsborgs Hospital, Borås, Sweden;2. Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden;3. Department of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Sweden;4. Department of Internal Medicine, Norra Älvsborgs Hospital, Trollhättan, Sweden;5. Department of Internal Medicine, Skaraborgs Hospital, Skövde, Sweden |
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| Abstract: | ObjectiveA significant proportion of patients with initial response to Inflximab (IFX), subsequently lose response (LOR). Multicentre paediatric studies report LOR in 33% to 50% with 3–5 year follow-up. Our retrospective study examined durability of response and predictors of LOR.MethodsFrom our IBD database of 185 children with CD, 65 received IFX maintenance therapy for luminal or fistulising Crohn's disease between January, 2006 and April, 2013. 47 with luminal CD ≥ 1 year follow-up after commencing IFX were included. We evaluated variables associated with response and describe outcomes on those remaining on IFX at four time points; before IFX, after induction, at 1 year and at the last follow-up. Response was divided into sustained primary, recovered, durable (combined sustained primary and recovered) and complete LOR (discontinuation from LOR or intolerance).ResultsOverall, 28/47 (60%) children sustained primary response over a median duration of 2.83 years (1.6–4.4, IQR). 19/47 (40%) developed LOR (including 2 intolerant) at a median of 11 months (9–19, IQR). Of 17 with LOR, 7 were successfully re-induced giving durable response (35/47, 74%); 6 failed dose intensification needing surgery (n = 2), second anti-TNF (n = 2) or both (n = 2). 4 had surgery without dose intensification.LOR was associated with low BMI at diagnosis, lower height Z scores prior to induction, elevated CRP following induction (p = 0.007) and failure to use concomitant IM (p = 0.02).ConclusionThe cumulative probability of durable response to IFX in luminal CD was 83%, 74% and 70% after 1, 2, and 3 years on IFX maintenance therapy. |
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