A prospective study of the efficacy and tolerance of a chimeric antibody to tumor necrosis factors (Remicade) in severe pediatric Crohn disease

被引:107
作者
Cezard, JP
Nouaili, N
Talbotec, C
Hugot, JP
Gobert, JG
Schmitz, J
Mougenot, JF
Alberti, C
Goulet, O
机构
[1] Hop Robert Debre, Serv Gastroenterol & Nutr Pediat, Pediat Gastroenterol Unit, F-75019 Paris, France
[2] Hop Necker Enfants Malad, Pediat Gastroenterol Unit, Paris, France
[3] Hop La Pitie Salpetriere, Lab Coprol, Paris, France
关键词
infliximab; pediatric; Crohn disease;
D O I
10.1097/00005176-200305000-00007
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objectives: To evaluate the efficacy and toxicity of infliximab in children with severe Crohn disease (CD), the authors prospectively monitored 21 children aged 15 +/- 2 years with severe CD who they treated with infliximab (5 mg/kg) on days 0, 15. and 45. One patient received only one injection. Eighteen patients were corticosteroid dependent, and 6 were receiving parenteral nutrition. Three patients were corticoid resistant (1 mg/kg/d >15 days). Sixteen had perianal disease. Results: The Harvey-Bradshaw index (HB) decreased from 8 3 on day 0 to 1 +/- 2 on day 45 (P = 0.001). The inflammation factors decreased (P = 0.001). and albumin increased (P = 0.002). Nineteen children were in complete remission (HB < 4) on day 45, and 2 had improved (HB = -6 points). Tumor necrosis factor-α (TNFα) in the stools (n = 16) decreased (P = 0,04). All perianal fistulas in = 12) were closed by day 90. Fourteen of 21 patients had stopped taking steroids at 3 months, and all had stopped parenteral nutrition. Growth velocity was significantly greater after infliximab administration (Z score, +0.5) than before (-0.45: P = 0.004). Nineteen of 21 patients had relapsed (90%) at 1 year despite continued immunosuppressors. Seven had surgery because of an uncontrolled relapse (5), stenosis (1). or fistula (1). Six patients developed antinuclear antibodies (1/40-1/640(e)), and two had anti-DNA antibodies. Epstein-Barr virus (EBV) polymerase chain reaction (PCR) values increased (>100-fold) in eight patients. One child developed an anaphylactic reaction to the medication, and one had a catheter-related sepsis. Conclusion: Infliximab produces spectacular results for children with severe CD and is well tolerated. However, its effect is transitory for many (90%), with frequent relapses despite continued immunosuppressors. Long-term management with infliximab should be tested despite its worrying side effects.
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收藏
页码:632 / 636
页数:5
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