Medical School, University of Western Australia, Crawley, WA, Australia.
Gastroenterology Department, Princess Margaret Hospital for Children, Perth, WA, Australia.
Dig Dis Sci. 2018 Apr;63(4):1003-1010. doi: 10.1007/s10620-018-4969-8. Epub 2018 Feb 26.
Earlier introduction of infliximab (IFX) in Crohn's disease (CD) may be associated with a sustained remission.
Children on scheduled IFX therapy for predominant luminal CD after successful induction (drop in PCDAI by ≥ 15) and a minimum of 2-year IFX follow-up were included. We compared outcomes of children treated with early (within 3 months from diagnosis) versus later IFX (after failing conventional therapy ≥ 3 months) and identify clinical predictors of sustained primary response (SPR) in our cohort. SPR was defined as CS-free clinical remission without requiring IFX dose escalation and/or surgical excision and/or switch to second anti-TNFs due to LOR or allergic reaction.
Sixty-four children received IFX therapy for CD during the study period. Forty-three children on scheduled IFX therapy for luminal CD met the inclusion criteria. During the median follow-up of 3.05 years (IQR 2.6-3.5 years), SPR was observed in 17/43 (40%). SPR was associated with shorter time from diagnosis to the initiation of IFX (5.4 vs. 18.7 months, p = 0.006). Binary logistic regression using multiple variables also confirmed that only early use of IFX is associated with SPR.
Early step-up use of IFX in children with CD with inadequate clinical response to conventional therapies leads to sustained primary response over 2 years.
在克罗恩病（CD）中更早地引入英夫利昔单抗（IFX）可能与持续缓解相关。
纳入了在成功诱导（PCDAI 下降≥15）后，按照计划接受 IFX 治疗以治疗主要腔内 CD 的儿童，并且有至少 2 年的 IFX 随访。我们比较了早期（诊断后 3 个月内）与晚期（在常规治疗失败≥3 个月后）接受 IFX 治疗的儿童的结局，并确定了我们队列中持续原发性反应（SPR）的临床预测因素。SPR 定义为无需 IFX 剂量增加和/或手术切除和/或由于 LOR 或过敏反应而转换为第二种抗 TNFs 即可实现无 IFX 剂量增加的临床缓解。
在研究期间，64 名儿童接受了 IFX 治疗 CD。43 名按计划接受 IFX 治疗腔 CD 的儿童符合纳入标准。在中位数为 3.05 年（IQR 2.6-3.5 年）的随访期间，观察到 43 名儿童中有 17 名（40%）出现 SPR。SPR 与从诊断到开始 IFX 的时间较短相关（5.4 与 18.7 个月，p=0.006）。使用多个变量的二元逻辑回归也证实，仅早期使用 IFX 与 SPR 相关。
在对常规治疗反应不足的 CD 儿童中早期逐步增加 IFX 的使用可在 2 年内实现持续的原发性反应。
