Predictors of response to Infliximab in children with luminal Crohn's disease

Grover, Zubin, Biron, Rebecca, Carman, Nicholas and Lewindon, Peter (2014) Predictors of response to Infliximab in children with luminal Crohn's disease. Journal of Crohn's and Colitis, 8 8: 739-746. doi:10.1016/j.crohns.2013.12.017


Author Grover, Zubin
Biron, Rebecca
Carman, Nicholas
Lewindon, Peter
Title Predictors of response to Infliximab in children with luminal Crohn's disease
Journal name Journal of Crohn's and Colitis   Check publisher's open access policy
ISSN 1876-4479
1873-9946
Publication date 2014-08-01
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.crohns.2013.12.017
Volume 8
Issue 8
Start page 739
End page 746
Total pages 8
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2015
Language eng
Formatted abstract
Objective
A 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.

Methods
From 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).

Results
Overall, 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).

Conclusion
The 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.
Keyword Infliximab
Paediatrics
Crohn's disease
Immunomodulators
Loss of response
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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