Use of infliximab in pediatric patients with inflammatory bowel disease

BACKGROUND: The concentration of tumor necrosis factor, a proinflammatory c ytokine, is increased in the gastrointestinal mucosa of patients with activ e Crohn's disease (CID) and ulcerative colitis (UC). Neutralization of tumo r necrosis factor decreases the mucosal inflammatory response of adults wit h CD. Little information is available on the use of monoclonal antibody to tumor necrosis factor (infliximab) in children and adolescents with CD or U C. OBJECTIVE: To evaluate the clinical response and side effects of patients t o infliximab. METHODS: A retrospective review of data regarding 18 pediatric and adolesce nt patients with active CID (n = 15) and UC (n = 3) poorly controlled with conventional therapy. All patients received one to six intravenous infusion s of infliximab 5 mg/kg, while receiving their usual medications. RESULTS: All patients experienced clinical improvement, including decrease in the frequency of stooling and resolution of extraintestinal symptoms suc h as arthropathy, malaise, and skin manifestations after treatment with inf liximab. All but one patient had a documented decrease in the erythrocyte s edimentation rate. Prednisone dosage was tapered in all but two patients, a nd discontinued in seven patients. Intravenous infusion of infliximab was w ell tolerated. One patient developed a rash several days after the infusion . A patient who received six infliximab infusions developed recurrent Staph ylococcus aureus infections, as well as septic arthritis and chronic osteom yelitis during the follow-up period, raising the issue of the long-term saf ety of infliximab. CONCLUSIONS: Treatment of our patients with refractory CID and UC with infl iximab was associated with remarkable clinical improvement. Although the dr ug may have an important role in their management, further assessment of lo ng-term safety and efficacy is needed.