Toepassing van infliximab bij kinderen en adolescenten met therapieresistente ziekte van Crohn in Nederland; ervaringen bij 23 patiënten

To describe the clinical experience of infliximab treatment in children and adolescents with refractory Crohn's disease in the Netherlands.

Design

Descriptive.

Method

From November 1998 to February 2002, 23 patients (aged 7-18 years) with refractory Crohn's disease or steroid-dependent Crohn's disease (with or without severe fistulas) were treated with infliximab. Patients were treated with 1-11 infusions, with an average follow-up of 14.5 months after the start of infliximab therapy.

Results

Ten patients had refractory Crohn's disease. Four of these showed good long-term response on infliximab treatment (modified ‘Paediatric Crohn's disease activity index’ (PCDAI) ≤ 10 points or growth acceleration after stunting). Twelve patients had Crohn's disease with severe fistulas. Five of these showed good long-term response (closure or non-productiveness of fistulas). One patient had metastatic Crohn's disease in the skin and showed good long-term response.

Conclusion

Response rates were lower than observed in previous studies. Specifically, a decrease of response was demonstrated after repeated infusion. The treatment frequency should be determined by the increase in complaints rather than using a fixed interval of 8 weeks.