Background Infliximab, the chimeric monoclonal IgG antibody to tumour necrosis factor-alpha, is indicated for medically refractory luminal and fistulising paediatric Crohn’s disease. Also, for ulcerative colitis care series in children and adolescents suggested that infliximab might be effective for treatment of ulcerative colitis resistant to standard medical terapy.
Aim To describe the clinical experience of infliximab therapy in the first 25 patients (children and adolescents) with refractory Crohn’s disease and ulcerative colitis treated in Fundeni Clinical Institute, Departament of Paediatric Gastroenterology.
Methods From February 2004 to November 2016, 25 patients, 17 with refractory Crohn’s disease or steroid dependent Crohn’s disease and 8 with ulcerative colitis were treated with infliximab. All patients received a baseline schedule of three intravenous infusions of infliximab (0, 2 and 6 weeks), 5 mg/kg and maintenance therapy with an infliximab infusions every 8 weeks. All patients had long-term administration of azathioprine or corticosteroids. Paediatric Crohn’s Disease Activity Index (PCDAI), nutritional and activity serum variables, and ileocolonoscopy (with histology) were evaluated before and after beginning therapy.
Results After 8 weeks of therapy all patients had a clinical remission (PCDAI < or=10 points). Six patients presenting a good long-term response. A significant increase in both weight and height was observed. In all patients corticostreroids were stopped in 8 weeks after beginning infliximab therapy. Immediate adverse reactions were observed in three children controlled by slowing infusion rate.
Conclusions Infliximab is highly effective treatment in children and adolescent with both severe refractory Crohn’s disease and ulcerative colitis. It is a safe and valuable treatment in inducing remission and promoting growth. Randomised controlled studies are mandatory to assess long-term efficacy and therapeutic strategy of infliximab therapy in children with IBD. There were no observed cases of TB infection nor cases of malignancies occurred.
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