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* = Presenting author

P634 Escalation of IFX therapy in paediatric versus adult inflammatory bowel disease patients: results from a prospective single-centre cohort study

D. Winter*1, C. van der Woude2, J. Escher1

1Children’s Hospital Erasmus MC Sophia, Department of Paediatric Gastroenterology, Rotterdam, Netherlands, 2Erasmus Medical Centre, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands

Background

Biological agents such as infliximab (IFX) represent a potent therapy for paediatric IBD (pIBD) and adult IBD patients (aIBD), both in Crohn’s disease (CD) and ulcerative colitis (UC). Clinical and endoscopic remission is reached within weeks after start if effective, but many patients will lose clinical response over time. It seems that secondary non-response to IFX treatment is more often seen in children, who have more severe and extensive disease. However, prospective data comparing clinical efficacy of IFX in children and adults are lacking. Our aim was to compare time to therapy adjustment and duration of sustained remission in pIBD and aIBD patients in their 1st year of IFX treatment.

Methods

We performed prospective follow-up of patients initiating IFX in our Centre. IFX dose of 5 mg/kg during induction (week 0, 2, and 6), and maintenance at a q8 week interval was considered standard therapy. Need for IFX escalation (dose intensification and/or interval shortening) at the discretion of the treating (paediatric) gastroenterologist was documented. Sustained clinical remission was defined as ongoing IFX therapy without exacerbations or need for additional therapy (except for IFX escalation).

Results

In total, 39 patients initiating IFX were included: 21 pIBD patients ≥ 6 years (median age 15.2 years (7.3–17.7); 14 CD vs 7 UC) and 18 aIBD patients (median age 34.1 years (19.0–72.8); 13 CD vs 5 UC). Mean time to IFX escalation was 30.3 vs 50.5 weeks for pIBD and aIBd, respectively (p < 0.001).

Figure 1. IFX therapy escalation.

Specifically paediatric UC patients had a shorter time to IFX escalation (11.3 vs 28.9 weeks for pIBD vs aIBD patients, respectively; p = 0.015). Mean duration of sustained clinical remission was not statistically different between pIBD and aIBD patients (36.9 vs 52.9 weeks, respectively; p = 0.078). Mean time to cessation of IFX therapy was not statistically different between pIBD and aIBD patients (44.5 vs 54.8 weeks; p = 0.324).

Figure 2. Duration of sustained clinical remission.

Conclusion

Our results indicate that pIBD patients more often undergo escalation of IFX therapy. Especially in paediatric UC, a starting dose of 5 mg/kg might not be efficient to induce and maintain sustained clinical remission because 80% of paediatric UC patients have had escalation of IFX therapy after 11 weeks. Duration of sustained clinical remission by IFX maintenance treatment is not statistically different between pIBD and aIBD patients.