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학술저널
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대한소아소화기영양학회 Pediatric Gastroenterology, Hepatology & Nutrition Pediatric Gastroenterology, Hepatology & Nutrition 제11권 제1호
발행연도
2008.1
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28 - 35 (8page)

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Purpose: The aim of this study is to report the efficacy of infliximab, a monoclonal antibody directed against tumor necrosis factor alpha which is used for both treatment of refractory pediatric Crohn disease (CD) and induction of remission. Methods: Among pediatric patients who were diagnosed with CD at Samsung Medical Center between March 2001 and August 2007, a total of 16 patients were given infliximab to treat conventional therapy- resistant refractory CD and severe active CD for induction of remission. Patients needing maintenance therapy were treated with an infliximab infusion every 8 weeks, and fistulizing CD patients occasionally received the infusion upon the condition that a fistula developed. The efficacy of treatment was assessed by comparing the Pediatric Crohn Disease Activity Index (PCDAI), Hct, ESR, CRP, and serum albumin levels using paired t-test. Results: The male/female ratio was 13：3, and the median age was 13 years (range, 21 months∼15 years). The patients included 7 cases of therapy-resistant refractory CD, 7 cases of severe active CD, and 2 cases of fistulizing CD. Mean PCDAI before infliximab therapy was 34.19±14.96, and mean follow-up PCDAI within 2 to 4 weeks after the last infusion was significantly lower, at 6.88±10.31 (p= 0.000). Hematological markers such as ESR (p=0.000), serum albumin (p=0.016), and CRP (p=0.009) also improved significantly after infusion. Remission was achieved in 2 of 4 patients refractory to conventional therapy. Among 3 steroid-dependent patients, 2 were able to discontinue steroid therapy, and dose reduction was possible in 1 patient. Remission after top-down therapy without prior use of other immunomodulators was achieved in 6 weeks in all 7 of the patients who had severe CD. Nine of ten refractory fistulizing CD patients also showed improvement after infliximab therapy. Conclusion: Infliximab was effective in pediatric refractory CD for induction of remission and maintenance therapy, as well as in severe CD for top-down induction therapy. Furthermore, infliximab has contributed to steroid cessation and dose reduction. Long-term follow-up evaluation is needed to determine safety and efficacy of infliximab in the future.
#Crohn disease #Infliximab #Children #Top-down treatment

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참고문헌 (26)

참고문헌 신청
Miele E / 2004 / Human antichimeric antibody in children and young adults with inflammatory bowel disease receiving infliximab / J Pediatr Gastroenterol Nutr 38:502~508 google schola Baert F / 2003 / Influence of immunogenicity on the long-term efficacy of infliximab in Crohn's disease / N Engl J Med 348:601~608 google schola / 2004 / TNF 길항제 사용시 잠복결핵 치료지침 / Korea Food and Drug Administration : 1 ~ 6 google schola Baldassano R / 2003 / Infliximab (REMICADE) therapy in the treatment of pediatric Crohn's disease / Am J Gastroenterol 98 : 833 ~ 838 google schola Cezard JP / 2003 / A prospective study of the efficacy and tolerance of a chimeric antibody to tumor necrosis factors (remicade) in severe pediatric Crohn disease / J Pediatr google schola

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