Infliximab "Top-Down" Strategy is Superior to "Step-Up" in Maintaining Long-Term Remission in the Treatment of Pediatric Crohn Disease
- Authors
- Lee, YM[Lee, Yoo Min]; Kang, B[Kang, Ben]; Lee, Y[Lee, Yoon]; Kim, MJ[Kim, Mi Jin]; Choe, YH[Choe, Yon Ho]
- Issue Date
- Jun-2015
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- Crohn disease; infliximab; pediatric; step-up; top-down
- Citation
- JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, v.60, no.6, pp.737 - 743
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION
- Volume
- 60
- Number
- 6
- Start Page
- 737
- End Page
- 743
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/43743
- DOI
- 10.1097/MPG.0000000000000711
- ISSN
- 0277-2116
- Abstract
- Objectives: We aimed to compare the efficacy of remission maintenance between infliximab "top-down" and "step-up" strategies in moderate to severe pediatric Crohn disease during 3 years. We also aimed to determine prognostic factors that may influence the relapse-free rate in these patients. Methods: The present study was a retrospective review of a prospective cohort, based on an infliximab treatment protocol for pediatric Crohn disease used at Samsung Medical Center. A total of 31 patients (group A) were treated with early infliximab induction ("top-down" strategy) and 20 patients (group B) refractory to conventional therapy underwent inffiximab treatment ("step-up" strategy). The efficacy of infliximab treatment was assessed by relapse-free rate and remission period rate for 3 years. A total of 11 prognostic factors that may influence the relapse-free rate were further analyzed. Results: The relapse-free rates at 3 years were 35.5% (95% confidence interval [CI] 0.194-0.519) in group A and 15.0% (95% CI 0.037-0.335) in group B (P= 0.0094). Overall remission period rate for 3 years also showed a significant difference between the 2 groups (92.1% +/- 7.2% vs 78.3% 16.6%; P=0.005). Multivariable analysis revealed that the duration from the initial diagnosis to infliximab infusion was the only factor associated with relapse-free remission for 3 years (hazard ratio = 1.077; 95% CI 1.025-1.131). Conclusions: "Top-down" strategy had a longer remission period compared with the "step-up" strategy in pediatric Crohn disease during a study period of 3 years, based on relapse-free rate and remission period rate. Earlier introduction of inffiximab is recommended in pediatric patients with moderate to severe Crohn disease.
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Collections - Medicine > Department of Medicine > 1. Journal Articles
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