Abstract

CAMPOS, Teresa Almeida et al. Treatment changes with infliximab in Crohn’s disease: Experience of a center. J Port Gastrenterol. [online]. 2014, vol.21, n.2, pp.55-59. ISSN 0872-8178.  https://doi.org/10.1016/j.jpg.2013.05.001.

Introduction: Treatment of Crohn disease in pediatric patients must ensure not only symptom control but also remission, allowing normal growth and development. Infliximab has been shown to be effective in controlling disease in children and adolescents unresponsive to first-line treatment, although 30 to 55% of failure occurs, requiring therapeutic adjustments. Recent pediatric studies have shown that the efficacy of reducing the range from 8 to 6/7 weeks, increasing the dose to 10 mg/kg dose or shortening the interval up to 4 weeks is similar. Objective and methods: Retrospective descriptive study of pediatric patients who were diagnosed with Crohn Disease and had infliximab treatment in last five years, with evaluation of treatment failure situations. Results: We included 16 patients (10 males, 6 females) treated with infliximab induction regimen, followed by 5 mg/kg every 8 weeks. In most patients, treatment was initiated 10 months after diagnosis. In 50% there was clinical and/or analytical relapse, on average after 10 cycles of treatment (median 6.5), leading to an adjustment of the therapeutic regimen: 6 shortened the interval to 6/7 weeks, 1 shortened the interval to 4 weeks and 1 increased the dose to 10 mg/kg. Of the 6 patients with 5 mg/kg dose and interval of 6/7 weeks, all had initial favorable response but 4 required an increase of the dose to 10 mg/kg, 2 of them are in remission. The disease remission with infliximab was 81.2%. Discussion: Treatment with infliximab was effective in controlling Crohn disease and in reducing the need of steroids, but dose adjustments were necessary, often occurring in the first year of treatment. Clinical changes determined the need of dose or interval increases or reductions. The predictable need to adjust treatment after a few months of treatment justifies that the choice of biologic therapy in Crohn disease has to be carefully considered after failure of other options.

Keywords : Crohn disease; Therapy; Infliximab.

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