Efficacy of Early Infliximab Treatment for Pediatric Crohn’s Disease: A Three-year Follow-up
이윤석, 백상훈, 이유민, 이윤, 최연호, 김미진,
소속 상세정보
이윤석 ( Lee Yun-Seok )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
백상훈 ( Baek Sang-Hun )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
이유민 ( Lee Yoo-Min )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
이윤 ( Lee Yoon )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
최연호 ( Choe Yon-Ho )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
김미진 ( Kim Mi-Jin )
Kwandong University College of Medicine Myongji Hospital Department of Pediatrics
KMID : 0816120120150040243
Abstract
Purpose: To investigate the efficacy of early infliximab use and to follow the progress of pediatric cases of Crohn’s disease for 3 years.
Methods: We reviewed the medical records of 28 pediatric patients who had been treated with infliximab for Crohn’s disease. Eighteen patients (the ’top-down’ group) received infliximab and azathioprine for induction and maintenance therapy for the first year, and then were treated with azathioprine for 2 additional years. Ten patients who were refractory to conventional therapy were categorized in the ’step-up’ group. All patients were followed for at least 36 months. Treatment efficacy was assessed by the relapse rate using the pediatric Crohn’s disease activity index (PCDAI) score in each group at 12, 24, and 36 months. Blood samples were available from 10 patients, and were used to assess antibody to infliximab (ATI).
Results: The relapse rate in ’top-down’ group was lower than that in ’step-up’ group at 1, 2, and 3 years. But, just the relapse rate at the 2 years was significantly different. At 3 years, the relapse rate according to different characteristic variables (sex, age at diagnosis, involvement, PCDAI at diagnosis) was not significantly different. Only one patient treated with infliximab had an adverse event, consisting of dyspnea and tachycardia. ATI was not detected in the blood samples from 10 patients.
Conclusion: Early induction with infliximab at diagnosis (’top-down’ therapy) is effective for reducing the relapse rate compared to conventional therapies in pediatric Crohn’s disease possibly for up to 3 years.
키워드
Infliximab;Pediatric Crohn’s disease;Relapse rate;Top-down treatment
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