Infliximab (IFX) has been shown to be a promising treatment option for children and adolescents with newly diagnosed moderate to severe Crohn disease (CD), according to the results of a trial published in Gut.  

A group of investigators from Erasmus Medical Center conducted a multicenter, open-label, randomized controlled trial that spanned across 12 hospitals in 3 countries (the Netherlands, Croatia, Finland) to determine if first-line infliximab (FL-IFX) is a more effective treatment to accomplish and sustain remission in comparison with conventional treatment, which is exclusive enteral nutrition (EEN) and oral prednisolone. The researchers recruited a total of 100 patients between the ages of 3 and 17 years with newly diagnosed untreated CD for the trial between April 7, 2015, and November 19, 2018. They assigned 50 participants to the FL-IFX group and gave 5 infusions of IFX 5 mg/kg at weeks 0, 2, 6, 14, and 22. They assigned the other 50 participants to the conventional group and gave them EEN or oral prednisolone (1 mg/kg; maximum 40 mg).

The researchers found that at week 10, a higher percentage of participants in the FL-IFX group than in the conventional group attained clinical (59% vs 34%; P =.021) and endoscopic (59% vs 17%; P =.001) remission. By week 52, 41% of patients treated with FL-IFX were in clinical remission on azathioprine monotherapy and did not need treatment escalation vs 15% of the patients in the conventional group.


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Although there were limitations in the trial, such as possible performance bias, missing endoscopic results for some patients, and differences in the length of therapy between the 2 groups, the researchers determined that FL-IFX produces more desirable outcomes for pediatric patients with moderate to severe CD when compared with conventional treatment methods. These findings suggest that more research and follow-up on IFX is warranted to determine the appropriate length of treatment and who will benefit most from treatment.

Reference

Jongsma, MME, Aardoom MA, Cozijnsen MA, et al. First-line treatment with infliximab versus conventional treatment in children with newly diagnosed moderate-to-severe Crohn’s disease: an open-label multicentre randomized controlled trial. Gut. Published online December 31, 2020. doi:10.1136/gutjnl-2020-322339