Lee Yun Seok, Baek Sang Hun, Kim Mi Jin, Lee Yoo Min, Lee Yoon, Choe Yon Ho
Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea.
Pediatr Gastroenterol Hepatol Nutr. 2012 Dec;15(4):243-9. doi: 10.5223/pghn.2012.15.4.243. Epub 2012 Dec 31.
To investigate the efficacy of early infliximab use and to follow the progress of pediatric cases of Crohn's disease for 3 years.
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).
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.
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.
研究早期使用英夫利昔单抗的疗效，并对儿童克罗恩病病例进行3年随访。
我们回顾了28例接受英夫利昔单抗治疗克罗恩病的儿科患者的病历。18例患者（“自上而下”组）在第一年接受英夫利昔单抗和硫唑嘌呤进行诱导和维持治疗，然后再接受2年硫唑嘌呤治疗。10例对传统治疗无效的患者被归类为“逐步升级”组。所有患者至少随访36个月。通过每组在12、24和36个月时使用儿童克罗恩病活动指数（PCDAI）评分的复发率来评估治疗效果。从10例患者中获取血样，用于评估抗英夫利昔单抗抗体（ATI）。
“自上而下”组在1年、2年和3年时的复发率低于“逐步升级”组。但是，仅2年时的复发率有显著差异。在3年时，根据不同特征变量（性别、诊断时年龄、受累情况、诊断时PCDAI）的复发率无显著差异。仅1例接受英夫利昔单抗治疗的患者出现不良事件，包括呼吸困难和心动过速。10例患者的血样中未检测到ATI。
与传统疗法相比，诊断时早期使用英夫利昔单抗（“自上而下”疗法）在儿童克罗恩病中可能长达3年对降低复发率有效。
