Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
Aliment Pharmacol Ther. 2011 Jan;33(2):243-50. doi: 10.1111/j.1365-2036.2010.04507.x. Epub 2010 Nov 14.
Infliximab is effective for induction and maintenance of remission in children with moderately to severely active Crohn's disease (CD).
To evaluate the long-term efficacy of infliximab treatment in paediatric CD.
In this observational, multicentre study, all paediatric CD patients in The Netherlands treated with infliximab from October 1992 to November 2009 and with minimal follow-up of 3 months since start of infliximab, were studied.
One hundred and fifty-two CD patients [81M; median age at start of infliximab 15.0 years (IQR 13.1-16.4)] received a median number of 10.5 infliximab infusions (IQR 6-21). Median follow-up after start of infliximab was 25 months (IQR 13-40). Kaplan-Meier analysis showed that the cumulative probability of losing response to infliximab in patients who initially required repeated infusions was 13%, 40% and 50% after 1, 3 and 5 years, respectively. Seventy-four patients (49%) needed dose adjustments, with a median time to any adjustment of 6 months.
Duration of effect of infliximab is limited as 50% of patients on infliximab maintenance treatment lose their therapeutic response after 5 years. Dose adjustments after start of infliximab are frequently needed to regain therapeutic benefit. These findings emphasise the need for effective, long-term treatment strategies for paediatric CD.
英夫利昔单抗对中重度活动期克罗恩病（CD）患儿的诱导缓解和维持缓解均有效。
评估英夫利昔单抗治疗小儿 CD 的长期疗效。
本研究为观察性、多中心研究，纳入了 1992 年 10 月至 2009 年 11 月期间荷兰所有接受英夫利昔单抗治疗且在开始英夫利昔单抗治疗后随访时间至少 3 个月的小儿 CD 患者。
共纳入 152 例 CD 患者[81 例男性；开始英夫利昔单抗治疗时的中位年龄为 15.0 岁（IQR 13.1-16.4）]，中位接受英夫利昔单抗输注次数为 10.5 次（IQR 6-21）。开始英夫利昔单抗治疗后的中位随访时间为 25 个月（IQR 13-40）。Kaplan-Meier 分析显示，最初需要重复输注的患者，英夫利昔单抗治疗的累积无应答概率分别为 1 年、3 年和 5 年后的 13%、40%和 50%。74 例（49%）患者需要调整剂量，中位调整时间为 6 个月。
英夫利昔单抗的疗效持续时间有限，50%接受英夫利昔单抗维持治疗的患者在 5 年后失去治疗应答。开始英夫利昔单抗治疗后需要频繁调整剂量以恢复治疗获益。这些发现强调了需要针对小儿 CD 制定有效的长期治疗策略。
