Safety and steroid-sparing experience using infliximab for Crohn's disease at a pediatric inflammatory bowel disease center

Abstract

OBJECTIVES: The published experience using infliximab (Remicade, Centocor, Malvern, PA) for the treatment of pediatric Crohn's disease is limited but suggests utility in the treatment of refractory disease. Experience using infliximab at a large pediatric center is reviewed. METHODS: A retrospective review of all infliximab infusions administered to patients with Crohn's disease (CD) was undertaken. Data were obtained from database and pharmacy records. Chart review and interviews with physicians, patients, and families were used to obtain missing data. RESULTS: A total of 432 infusions were administered to 82 patients (34 female and 48 male) with CD. The number of infusions each patient received ranged from one to 18, with a mean of 5.3 (SD 4.6) and median of 3. Of 33 patients, 19 (57.6%) became independent and remained free of corticosteroids. There was a statistically significant difference in the steroid dose between 0 and 4 wk and 0 and 8 wk. In all, 23 infusion reactions occurred (5.3%). Three patients developed herpes zoster, and one developed Listeria monocytogenes meningitis. No patients were documented to have delayed hypersensitivity reactions or malignancies. CONCLUSIONS: Infliximab is safe and effective for treating pediatric patients with CD. A steroid-sparing effect was demonstrated. The most common adverse reaction to infliximab was infusion reaction. These reactions did not preclude further use of the agent. Serious infections were seen in a small number of patients.