ABSTRACT
BACKGROUND: Infliximab is effective for induction and maintenance of remission in children with moderately to severely active Crohn's disease (CD). AIM: To evaluate the long-term efficacy of infliximab treatment in paediatric CD. METHODS: In this observational, multicentre study, all paediatric CD patients in The Netherlands treated with infliximab from October 1992 to November 2009 and with minimal follow-up of 3 months since start of infliximab, were studied. RESULTS: One hundred and fifty-two CD patients [81M; median age at start of infliximab 15.0 years (IQR 13.1-16.4)] received a median number of 10.5 infliximab infusions (IQR 6-21). Median follow-up after start of infliximab was 25 months (IQR 13-40). Kaplan-Meier analysis showed that the cumulative probability of losing response to infliximab in patients who initially required repeated infusions was 13%, 40% and 50% after 1, 3 and 5 years, respectively. Seventy-four patients (49%) needed dose adjustments, with a median time to any adjustment of 6 months. CONCLUSIONS: Duration of effect of infliximab is limited as 50% of patients on infliximab maintenance treatment lose their therapeutic response after 5 years. Dose adjustments after start of infliximab are frequently needed to regain therapeutic benefit. These findings emphasise the need for effective, long-term treatment strategies for paediatric CD.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Gastrointestinal Agents/therapeutic use , Adolescent , Child , Crohn Disease/drug therapy , Female , Follow-Up Studies , Humans , Infliximab , Male , Netherlands , Time Factors , Treatment OutcomeSubject(s)
Dendritic Cells/metabolism , Inflammatory Bowel Diseases/metabolism , Interleukin-12/biosynthesis , Interleukin-23/biosynthesis , Adolescent , Antigens, Differentiation, T-Lymphocyte/metabolism , Child , Child, Preschool , Colitis, Ulcerative/metabolism , Crohn Disease/metabolism , Humans , Inflammatory Bowel Diseases/diagnosis , Monocytes/metabolismABSTRACT
The growth pattern of 28 girls and 32 boys with celiac disease was analyzed up to the ages of 10 and 12 years, respectively. Fifty-four patients (90%) were diagnosed before 4 years of age and six patients (10%) between 5 and 9 years of age. At diagnosis, 18 of 60 patients (30%) had a height SD score below -2.0, and 45 of 59 patients (76%) had a weight-for-height below the median. The mean height SD score showed increasing growth retardation in the year before diagnosis, relatively quick catch-up growth in the year after diagnosis, and complete catch-up in 2-3 years. Mean weight-for-height showed a progressive decrease 12-18 months before diagnosis, increased to a maximum at the end of the first year of therapy, and returned to normal 15 months after dietary treatment. Independent of age at diagnosis, initial degree of wasting, diagnostic delay, and strictness of gluten-free diet, catch-up growth was complete in this group of patients who were diagnosed before 9 years of age.
