%0 Journal Article
%T Loss of Response to Long-Term Infliximab Therapy in Children with Crohn¡¯s Disease
%A Oliver Gouldthorpe
%A Anthony G. Catto-Smith
%A George Alex
%A Di Simpson
%J Pharmaceuticals
%D 2013
%I MDPI AG
%R 10.3390/ph6101322
%X Secondary loss of response (LoR) often precludes further use of infliximab in children with Crohn¡¯s disease. Immunomodulators may reduce the incidence of LoR but their combination with infliximab presents safety concerns. We aimed to determine the long-term durability of infliximab response in paediatric Crohn¡¯s, effect of immunomodulators on LoR, and secondarily the effect of infliximab on growth. We retrospectively audited patients on maintenance infliximab at a single centre. Data included height and weight, Paediatric Crohn¡¯s Disease Activity Index (PCDAI), and immunomodulator use. 71 children (32% female, mean age 14.4 years) had been commenced on maintenance infliximab before July 2011. 89% had been on immunomodulators concurrently with infliximab. LoR occurred in 20 (28%), with a median time to LoR of 4.31 years. LoR was significantly increased in children who did not enter remission (PCDAI ¡Ü 10) after induction ( p < 0.05). LoR occurred more frequently in the 72% who ceased immunomodulators, but this failed to reach statistical significance ( p = 0.300). Height and weight SDS improved significantly on infliximab. Infliximab is a durable long-term therapy for paediatric Crohn¡¯s refractory to conventional therapy. A large-magnitude increase in the rate of loss of response after immunomodulator cessation was not observed.
%K Crohn¡¯s disease
%K paediatrics
%K infliximab
%K immunomodulator
%K growth
%U http://www.mdpi.com/1424-8247/6/10/1322