deBruyn JC, et al. - In this study, infliximab optimization and durability in children with Crohn's disease were evaluated. A durable response to infliximab was maintained in children with Crohn's disease. Optimization occurred frequently and allowed for continued use. Factors associated with increased need for infliximab optimization were the younger age at diagnosis and nonstricturing, nonpenetrating behavior.

Methods

• A retrospective review was performed of children with Crohn’s disease who started infliximab from January 2008 to December 2012 in 4 Canadian tertiary care centers.
• The researchers evaluated a priori factors associated with optimization and discontinuation from loss of response using logistic regression and Cox proportional hazards model, respectively.

Results

• The researchers started infliximab in 180 children (54.4% boys); all completed induction.
• At infliximab start, median age was 14.3 years (Q1, Q3: 12.8, 15.9 years) and median time from diagnosis to infliximab start was 1.5 years (Q1, Q3: 0.6, 3.5 years).
• In this study, 87.1% were maintained on infliximab at last follow-up (median duration follow-up 85.9 weeks [Q1, Q3: 43.8, 138.8 weeks]).
• They noted infliximab optimization in 57.3% (dose escalation 15.2%, interval shortening 3.9%, both 38.2%), primarily because of loss of response.
• Factors associated with optimization were younger age at diagnosis (<10 years old) and nonstricturing, nonpenetrating behavior (odds ratio 6.5, 95% confidence interval [CI] 2.0-21.1 and odds ratio 2.1, 95% CI 1.0-4.2, respectively).
• The 1- and 2-year durability of infliximab (percentage in follow-up who were continuing on infliximab) were 95.5% (95% CI 90.4–98.3) and 91.0% (95% CI 82.4-96.3), respectively.
• Findings revealed that annual discontinuation because of loss of response occurred at 3.2% per year (95% CI 1.1-5.2).