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Long‐term Outcomes of Infliximab Use for Pediatric Crohn Disease

2017; Lippincott Williams & Wilkins; Volume: 66; Issue: 2 Linguagem: Inglês

10.1097/mpg.0000000000001672

1536-4801

Jennifer deBruyn, Kevan Jacobson, Wael El‐Matary, Matthew Carroll, Eytan Wine, Iwona Wrobel, Mariel Van Woudenberg, Hien Q. Huynh,

Autoimmune and Inflammatory Disorders Research

ABSTRACT Background: Data on long‐term real‐world outcomes of infliximab in pediatric Crohn disease are limited. Aim: The aim of the study was to evaluate infliximab optimization and durability in children with Crohn disease. Methods: We performed a retrospective review of children with Crohn disease who started infliximab from January 2008 to December 2012 in 4 Canadian tertiary care centers. A priori factors associated with optimization and discontinuation from loss of response were evaluated using logistic regression and Cox proportional hazards model, respectively. Results: One hundred eighty children (54.4% boys) started infliximab; all completed induction. Median age at infliximab start was 14.3 years (Q1, Q3: 12.8, 15.9 years) and median time from diagnosis to infliximab start was 1.5 years (Q1, Q3: 0.6, 3.5 years). At last follow‐up, 87.1% were maintained on infliximab (median duration follow‐up 85.9 weeks [Q1, Q3: 43.8, 138.8 weeks]). Infliximab optimization occurred in 57.3% (dose escalation 15.2%, interval shortening 3.9%, both 38.2%), primarily due to loss of response. Younger age at diagnosis (<10 years old) and nonstricturing, nonpenetrating behavior were associated with optimization (odds ratio 6.5, 95% confidence interval [CI] 2.0–21.1 and odds ratio 2.1, 95% CI 1.0–4.2, respectively). The 1‐ and 2‐year durability of infliximab (percentage in follow‐up who were continuing on infliximab) were 95.5% (95% CI 90.4–98.3) and 91.0% (95% CI 82.4–96.3), respectively. Annual discontinuation due to loss of response occurred at 3.2% per year (95% CI 1.1–5.2). Conclusions: Children with Crohn disease maintain a durable response to infliximab. Optimization occurs frequently and allows for continued use. Younger age at diagnosis and nonstricturing, nonpenetrating behavior are associated with increased need for infliximab optimization.