Long-term outcome of maintenance infliximab therapy in children with Crohn's disease

Jeffrey S. Hyams, Trudy Lerer, Anne Griffiths, Marian Pfefferkorn, Subra Kugathasan, Jonathan Evans, Anthony Otley, Ryan Carvalho, David Mack, Athos Bousvaros, Joel Rosh, Petar Mamula, Marsha Kay, Wallace Crandall, Maria Oliva-Hemker, David Keljo, Neal LeLeiko, James Markowitz

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

Background: Infliximab therapy has short-term benefits in children with moderate-to-severe Crohn's disease (CD). We assessed the long-term outcome of infliximab maintenance therapy in children with CD. Methods: We performed a multicenter cohort study of 729 pediatric patients with CD enrolled in the Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry. Children younger than 16 years and newly diagnosed with CD were eligible for this study. Disease and medication information were collected prospectively from the treating physician at diagnosis, 30 days, and quarterly thereafter. No interventions were specified, per protocol. Results: In all, 202 of 729 patients received infliximab: 62%, 23%, and 15% within 1, 1-2, and >2 years of diagnosis, respectively. The mean age at infliximab initiation was 12.7 years. A total of 158 infliximab-treated patients received maintenance therapy, 29 episodic (8 converted to maintenance), and 15 had incomplete follow-up. Among 128 patients administered maintenance infliximab and followed for ≥1 year, concomitant medications at infliximab initiation included corticosteroids (52%) and immunomodulators (90%). By 1, 2, and 3 years, <10% of patients continuing on maintenance infliximab were receiving corticosteroids (P < 0.001). Following maintenance therapy initiation, 26%, 44%, and 33% of patients continuing on maintenance infliximab over 0-1, 1-2, and 2-3 years, respectively, had clinically inactive disease not requiring corticosteroids or surgery. The likelihood of continuing maintenance infliximab at 1, 2, and 3 years was 93%, 78%, and 67%, respectively. Conclusions: Infliximab maintenance therapy was a durable and effective treatment that was associated with prolonged corticosteroid withdrawal over a 3-year period in children with CD.

Original languageEnglish (US)
Pages (from-to)816-822
Number of pages7
JournalInflammatory bowel diseases
Volume15
Issue number6
DOIs
StatePublished - Jul 16 2009
Externally publishedYes

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Crohn Disease
Maintenance
Adrenal Cortex Hormones
Therapeutics
Infliximab
Pediatrics
Immunologic Factors
Inflammatory Bowel Diseases
Multicenter Studies
Registries
Cohort Studies
Physicians

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Gastroenterology

Cite this

Hyams, J. S., Lerer, T., Griffiths, A., Pfefferkorn, M., Kugathasan, S., Evans, J., ... Markowitz, J. (2009). Long-term outcome of maintenance infliximab therapy in children with Crohn's disease. Inflammatory bowel diseases, 15(6), 816-822. https://doi.org/10.1002/ibd.20845
Hyams, Jeffrey S. ; Lerer, Trudy ; Griffiths, Anne ; Pfefferkorn, Marian ; Kugathasan, Subra ; Evans, Jonathan ; Otley, Anthony ; Carvalho, Ryan ; Mack, David ; Bousvaros, Athos ; Rosh, Joel ; Mamula, Petar ; Kay, Marsha ; Crandall, Wallace ; Oliva-Hemker, Maria ; Keljo, David ; LeLeiko, Neal ; Markowitz, James. / Long-term outcome of maintenance infliximab therapy in children with Crohn's disease. In: Inflammatory bowel diseases. 2009 ; Vol. 15, No. 6. pp. 816-822.
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Hyams, JS, Lerer, T, Griffiths, A, Pfefferkorn, M, Kugathasan, S, Evans, J, Otley, A, Carvalho, R, Mack, D, Bousvaros, A, Rosh, J, Mamula, P, Kay, M, Crandall, W, Oliva-Hemker, M, Keljo, D, LeLeiko, N & Markowitz, J 2009, 'Long-term outcome of maintenance infliximab therapy in children with Crohn's disease', Inflammatory bowel diseases, vol. 15, no. 6, pp. 816-822. https://doi.org/10.1002/ibd.20845

Long-term outcome of maintenance infliximab therapy in children with Crohn's disease. / Hyams, Jeffrey S.; Lerer, Trudy; Griffiths, Anne; Pfefferkorn, Marian; Kugathasan, Subra; Evans, Jonathan; Otley, Anthony; Carvalho, Ryan; Mack, David; Bousvaros, Athos; Rosh, Joel; Mamula, Petar; Kay, Marsha; Crandall, Wallace; Oliva-Hemker, Maria; Keljo, David; LeLeiko, Neal; Markowitz, James.

In: Inflammatory bowel diseases, Vol. 15, No. 6, 16.07.2009, p. 816-822.

Research output: Contribution to journalArticle

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T1 - Long-term outcome of maintenance infliximab therapy in children with Crohn's disease

AU - Hyams, Jeffrey S.

AU - Lerer, Trudy

AU - Griffiths, Anne

AU - Pfefferkorn, Marian

AU - Kugathasan, Subra

AU - Evans, Jonathan

AU - Otley, Anthony

AU - Carvalho, Ryan

AU - Mack, David

AU - Bousvaros, Athos

AU - Rosh, Joel

AU - Mamula, Petar

AU - Kay, Marsha

AU - Crandall, Wallace

AU - Oliva-Hemker, Maria

AU - Keljo, David

AU - LeLeiko, Neal

AU - Markowitz, James

PY - 2009/7/16

Y1 - 2009/7/16

N2 - Background: Infliximab therapy has short-term benefits in children with moderate-to-severe Crohn's disease (CD). We assessed the long-term outcome of infliximab maintenance therapy in children with CD. Methods: We performed a multicenter cohort study of 729 pediatric patients with CD enrolled in the Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry. Children younger than 16 years and newly diagnosed with CD were eligible for this study. Disease and medication information were collected prospectively from the treating physician at diagnosis, 30 days, and quarterly thereafter. No interventions were specified, per protocol. Results: In all, 202 of 729 patients received infliximab: 62%, 23%, and 15% within 1, 1-2, and >2 years of diagnosis, respectively. The mean age at infliximab initiation was 12.7 years. A total of 158 infliximab-treated patients received maintenance therapy, 29 episodic (8 converted to maintenance), and 15 had incomplete follow-up. Among 128 patients administered maintenance infliximab and followed for ≥1 year, concomitant medications at infliximab initiation included corticosteroids (52%) and immunomodulators (90%). By 1, 2, and 3 years, <10% of patients continuing on maintenance infliximab were receiving corticosteroids (P < 0.001). Following maintenance therapy initiation, 26%, 44%, and 33% of patients continuing on maintenance infliximab over 0-1, 1-2, and 2-3 years, respectively, had clinically inactive disease not requiring corticosteroids or surgery. The likelihood of continuing maintenance infliximab at 1, 2, and 3 years was 93%, 78%, and 67%, respectively. Conclusions: Infliximab maintenance therapy was a durable and effective treatment that was associated with prolonged corticosteroid withdrawal over a 3-year period in children with CD.

AB - Background: Infliximab therapy has short-term benefits in children with moderate-to-severe Crohn's disease (CD). We assessed the long-term outcome of infliximab maintenance therapy in children with CD. Methods: We performed a multicenter cohort study of 729 pediatric patients with CD enrolled in the Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry. Children younger than 16 years and newly diagnosed with CD were eligible for this study. Disease and medication information were collected prospectively from the treating physician at diagnosis, 30 days, and quarterly thereafter. No interventions were specified, per protocol. Results: In all, 202 of 729 patients received infliximab: 62%, 23%, and 15% within 1, 1-2, and >2 years of diagnosis, respectively. The mean age at infliximab initiation was 12.7 years. A total of 158 infliximab-treated patients received maintenance therapy, 29 episodic (8 converted to maintenance), and 15 had incomplete follow-up. Among 128 patients administered maintenance infliximab and followed for ≥1 year, concomitant medications at infliximab initiation included corticosteroids (52%) and immunomodulators (90%). By 1, 2, and 3 years, <10% of patients continuing on maintenance infliximab were receiving corticosteroids (P < 0.001). Following maintenance therapy initiation, 26%, 44%, and 33% of patients continuing on maintenance infliximab over 0-1, 1-2, and 2-3 years, respectively, had clinically inactive disease not requiring corticosteroids or surgery. The likelihood of continuing maintenance infliximab at 1, 2, and 3 years was 93%, 78%, and 67%, respectively. Conclusions: Infliximab maintenance therapy was a durable and effective treatment that was associated with prolonged corticosteroid withdrawal over a 3-year period in children with CD.

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Hyams JS, Lerer T, Griffiths A, Pfefferkorn M, Kugathasan S, Evans J et al. Long-term outcome of maintenance infliximab therapy in children with Crohn's disease. Inflammatory bowel diseases. 2009 Jul 16;15(6):816-822. https://doi.org/10.1002/ibd.20845