Infliximab treatment time and the mucosal healing effect in pediatric patients with severe Crohn’s disease – own experience

Introduction: Mucosal healing is of vital importance for complete and sustainable clinical remission of Crohn’s disease (CD).

Aim: To evaluate the effect of the infliximab (IFX) treatment duration on mucosal healing and clinical remission in pediatric patients with severe CD.

Material and methods: The authors analyzed data of 10 children aged 6-18 treated with IFX (5 mg/kg; induction: 0, 2, 6 weeks, continuation: every 4 or 8 weeks). The disease activity (Pediatric Crohn’s Disease Activity Index – PCDAI) and mucosal healing (Simple Endoscopic Score for Crohn's Disease – SES-CD) were assessed one month after the 3rd, 6th and 9th IFX dose.

Results: After 3, 6, 9 IFX doses clinical remission (PCDAI  10 points) was observed respectively in 5 (50%), 7 (70%), 7 (70%) patients and clinical response (11 points  PCDAI  30 points) in 2 (20%), 2 (20%) and 1 (10%) patients. Endoscopic remission (SES-CD) was seen respectively in 1 (10%), 2 (20%) and 4 (40%) patients.

Conclusions: In the majority of children with severe CD not responding to conventional treatment the biological IFX treatment induces clinical remission. Prolonged treatment with IFX increases the number of remissions. During the IFX therapy clinical response is observed significantly earlier than mucosal healing. Continuation of the therapy in children with positive clinical response to IFX enhances further mucosal healing and allows steroids to be discontinued. In patients who lose response to the IFX therapy during the maintenance treatment the therapeutic effect can be restored by shortening intervals between doses or by doubling the dose.