Child/Adolescent Health

Infliximab is a safe and effective therapeutic option for children with sever ulcerative colitis

Infliximab (Remicade®), a drug that blocks the inflammatory action of the body's tumor necrosis factor-a (TFA), is a safe and effective therapeutic option for pediatric patients with severe ulcerative colitis (UC), concludes a new study. It is more effective in acutely ill children with UC than in children with chronic steroid-dependent UC. Also, children treated with infliximab can be weaned from the medication and maintain remission of UC and its symptoms ranging from nocturnal diarrhea to fecal incontinence and abdominal pain. Pediatric patients with UC seem to tolerate infliximab as well as adults with UC and children with Crohn's disease (another inflammatory bowel disease).

Researchers reviewed the charts of 27 children with UC who were treated with infliximab instead of undergoing a colectomy (surgical removal of all or part of the colon). Sixteen patients with new-onset UC, which did not respond to intravenous steroids for 5 to 10 days, and patients with non-steroid-dependent UC with an acute worsening of the condition were classified as acutely ill. Eleven patients with chronic steroid-dependent UC were classified as chronically ill. Patients were regarded as successfully treated if they remained off steroids and avoided colectomy.

Acutely ill children were nearly 3 times more likely to be successfully treated than were the chronically ill patients. The acutely ill group had a mean Lichtiger Colitis Activity Index (LCAI) score of 11.4 at initial infusion of the medicine and 0.3 after 2 months of treatment. The chronically ill group had a mean LCAI score of 11.2 at initial infusion and 5.5 after 2 months. LCAI scores of 10 or higher indicate active disease and no response to current therapy, scores below 10 suggest a response to therapy, and scores of 2 or lower indicate disease in remission.

Treatment with infliximab was successful in 75 percent of acutely ill patients and in 27 percent of chronically ill patients. Infliximab was discontinued in 80 percent of successfully treated patients, after an average of 10 infusions and a mean of 10 months from their last infliximab infusion. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00060).

More details are in "Short- and long-term response to and weaning from infliximab therapy in pediatric ulcerative colitis," by Gary Fanjiang, M.D., George H. Russell, M.D., and Aubrey J. Katz, M.D., in the March 2007 Journal of Pediatric Gastroenterology and Nutrition 44, pp. 312-317.

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