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P470. Infliximab treatment for paediatric Crohn's disease: long-term outcomes at a single centre

P. Church1, J. Guan1, K. Frost1, A. Muise1, T. Walters1, A. Griffiths1, 1Hospital for Sick Children, Paediatrics, Toronto, Canada

Background

Infliximab (IFX) is effective in treating luminal Crohn's disease (CD) in children (Hyams, 2007), but data about durability of response are limited. We reviewed the effectiveness of IFX treatment in achieving short- and long-term clinical remission and normal linear growth in a single-center cohort.

Methods

From 2000 to 2011 at SickKids, Toronto, 195 children (63% male; median age 14.1 yrs, IQR 3.3) with luminal inflammatory CD (20% L1; 17% L2; 63% L3) received standard IFX 3-dose induction. Median duration of diagnosed CD at initiation was 19.9 mos (range 0.3–136.8). Responders continued scheduled maintenance treatment +/− immunomodulator (IM). Records were retrospectively reviewed to extract at yearly intervals: physician global assessment (PGA) of continued response/remission vs. loss of response (LoR), PCDAI, linear growth, colonoscopic data and levels of IFX and antibodies (ATI). Durability of response was explored using survival analysis.

Results

Rates of clinical response (judged by PGA) and remission (judged by PGA and PCDAI ≤10) were respectively, 91% and 80%. Longer time from diagnosis to IFX induction and being female were associated with a lower response rate. 20% of primary responders later stopped IFX (LoR: 56%; intolerance/complication: 30%). LoR rate was linear (6 to 8%/year) over 5 years. Over the follow-up period, 52% required dose escalation or interval shortening. In subjects with LoR, ATI were present in 88%. Concurrent IM use did not significantly alter LoR, ATI or need for dose escalation. Data for growth are shown in the figure. Growth was significantly improved for those who were Tanner 1 or 2 at induction. Being younger at diagnosis and induction were significantly associated with improved height. Follow-up endoscopy was performed in 26 patients after IFX induction. Healing was observed in 50% (35% substantial, 15% complete).

Figure: Height improves significantly when growth potential remains at induction.

Conclusion

These long-term data support the effectiveness of IFX in achieving durable response and improving growth in patients with luminal Crohn's disease.