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P446. Infliximab is an effective induction therapy in children with perianal fistulizing Crohn's disease

A. Wegner, M. Dadalski, J. Kierkus, Children's Memorial Health Institute, Gastroenterology, Hepatology and Feeding Disorders, Warsaw, Poland

Background

Infliximab is applied in the treatment of Crohn's Disease (CD) in pediatric patients, who do not respond to conventional therapy or/and in case of perianal fistulizing CD. Overall efficacy of induction therapy with infliximab in children with CD is up to 80%, whereas in adult subgroup with perianal fistulizing CD induction therapy is successful in about 60% cases. The aim of this study was to assess the efficacy of induction therapy with infliximab in children with perianal fistulizing Crohn's disease.

Methods

This is a subanalysis of CIMIT study. The subgroup of 25 patients (19M, 6F; age 14.2±3.1 years; CD duration 1.8±1.8 years; PCDAI 48.4±12 [mean±SD]) with PCDAI >30 and perianal fistula present were involved to the study and received induction therapy with infliximab 5 mg/kg at weeks 0, 2, and 6. Clinical (PCDAI score) response (decrease of PCDAI greater or equal than 15 and total PCDAI smaller - than 30) and remission (PCDAI smaller or equal than 10) were assessed at Week 10 as well as fistulas' healing.

Results

1 patient had induction therapy stopped due to VZV infection. 21 out of 25 (84%) pts had clinical response, and 16 out of them (64%) had clinical remission at the end of induction therapy. Fistula closure was found in 16 of 25 patients (64%) at 10 weeks study. 3 out of 4 patients with no response still had active fistulas at Week 10 and among 9 patients with active fistulas at Week 10, 4 had clinical remission (fistula was the only symptom of CD) and 7 had clinical response.

Conclusion

Infliximab is an effective induction therapy in children with perianal fistulizing Crohn's Disease with successful fistulas closure in 64% cases. The majority of patients with no fistula healing had also clinical benefit with such a therapy.