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Infliximab Therapy for Children with Moderate to Severe Ulcerative Colitis: A Step-Up versus a Top-Down Strategy

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Purpose: We aimed to investigate clinical outcomes between top-down (TD) and conventional step-up (SU) therapies in pediatricpatients with moderate to severe ulcerative colitis (UC). Materials and Methods: All patients underwent clinical and endoscopic evaluation at diagnosis and 4 months and 1 year aftertreatment. Patients who started treatment with corticosteroid were grouped in the SU group, while those that initiated early infliximab(IFX) were grouped in the TD group. Among the SU group, patients who eventually changed to IFX treatment due to steroidresistance or dependency were included in the SU(R) group. Results: In total, 44 children with moderate to severe UC were included for analysis. Twenty-one patients were included in the SUgroup, 23 were included in the TD group, and 10 were enrolled in the SU(R) group. Relapse rates were 47.6% (10/21) in the SUgroup and 17.4% (4/23) in the TD group (p=0.033). Among relapsed patients, the durations from remission to relapse were 17.3months (0.9–46.9) in the SU group and 24.3 months (1.8–44.9) in the TD group. There was no statistically significant difference inthe sustained durations of remission after IFX administration between the SU(R) and TD groups [3.9 (1.4–6.3) and 2.3 (0.3–5.2)years, respectively (p>0.05)]. Conclusion: According to our study, early use of IFX without corticosteroid treatment for children with moderate to severe UChelps to lower relapse rates. We also found that IFX was a very effective treatment for pediatric UC, with a sustained duration ofremission similar between TD and SU(R) groups.

Abstract

Purpose: We aimed to investigate clinical outcomes between top-down (TD) and conventional step-up (SU) therapies in pediatricpatients with moderate to severe ulcerative colitis (UC). Materials and Methods: All patients underwent clinical and endoscopic evaluation at diagnosis and 4 months and 1 year aftertreatment. Patients who started treatment with corticosteroid were grouped in the SU group, while those that initiated early infliximab(IFX) were grouped in the TD group. Among the SU group, patients who eventually changed to IFX treatment due to steroidresistance or dependency were included in the SU(R) group. Results: In total, 44 children with moderate to severe UC were included for analysis. Twenty-one patients were included in the SUgroup, 23 were included in the TD group, and 10 were enrolled in the SU(R) group. Relapse rates were 47.6% (10/21) in the SUgroup and 17.4% (4/23) in the TD group (p=0.033). Among relapsed patients, the durations from remission to relapse were 17.3months (0.9–46.9) in the SU group and 24.3 months (1.8–44.9) in the TD group. There was no statistically significant difference inthe sustained durations of remission after IFX administration between the SU(R) and TD groups [3.9 (1.4–6.3) and 2.3 (0.3–5.2)years, respectively (p>0.05)]. Conclusion: According to our study, early use of IFX without corticosteroid treatment for children with moderate to severe UChelps to lower relapse rates. We also found that IFX was a very effective treatment for pediatric UC, with a sustained duration ofremission similar between TD and SU(R) groups.

참고문헌 (33)

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