Corticosteroid Therapy in the Age of Infliximab: Acute and 1-Year Outcomes in Newly Diagnosed Children With Crohn's Disease

James Markowitz, Jeffrey Hyams, David Mack, Neal LeLeiko, Jonathan Evans, Subra Kugathasan, Marian Pfefferkorn, Adam Mezoff, Joel Rosh, Vasundhara Tolia, Anthony Otley, Anne Griffiths, M. Susan Moyer, Maria Oliva-Hemker, Robert Wyllie, Robert Rothbaum, Athos Bousvaros, J. Fernando Del Rosario, Sandra Hale, Trudy Lerer

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Abstract

Background & Aims: The aim of this study was to describe 3-month and 1-year outcomes of children with Crohn's disease (CD) treated with corticosteroids within 30 days of diagnosis, with particular emphasis on the influence of infliximab on these outcomes. We also aimed to determine whether there are clinical or laboratory characteristics associated with corticosteroid therapy outcomes. Methods: Data from 109 children were drawn from a multicenter observational registry that was started in 2002. Clinical characteristics and data on corticosteroid and other therapies were recorded prospectively. Corticosteroid therapy outcomes at 3 months were defined as complete acute response, partial response, or corticosteroid resistance. At 1 year, corticosteroid responsiveness, dependence, and surgical rates were determined. Infliximab's influence on short- and long-term outcomes also was investigated. Results: At 3 months, 65 of 109 (60%) patients had a complete acute response to corticosteroids, 26 (24%) had a partial response, and 18 (17%) were corticosteroid resistant. At 1 year, 61% were corticosteroid responsive, 31% were corticosteroid dependent, and 8% required surgery. Irrespective of the duration of corticosteroid treatment, 16 of 24 of corticosteroid-dependent/resistant patients rapidly discontinued corticosteroids after starting infliximab. No clinical or laboratory characteristics at diagnosis predicted short-term outcome. Growth impairment at diagnosis increased risk for corticosteroid dependence or surgery at 1 year. Conclusions: At 3 months, 84% of children had a complete or partial response to corticosteroids. However, despite concomitant immunomodulators, at 1 year 31% were corticosteroid dependent and 8% required surgery. Infliximab improves outcomes of corticosteroid-dependent/resistant patients because the duration of corticosteroid use can be controlled by initiating treatment with infliximab.

Original languageEnglish (US)
Pages (from-to)1124-1129
Number of pages6
JournalClinical Gastroenterology and Hepatology
Volume4
Issue number9
DOIs
StatePublished - Sep 1 2006

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ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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Markowitz, J., Hyams, J., Mack, D., LeLeiko, N., Evans, J., Kugathasan, S., Pfefferkorn, M., Mezoff, A., Rosh, J., Tolia, V., Otley, A., Griffiths, A., Moyer, M. S., Oliva-Hemker, M., Wyllie, R., Rothbaum, R., Bousvaros, A., Del Rosario, J. F., Hale, S., & Lerer, T. (2006). Corticosteroid Therapy in the Age of Infliximab: Acute and 1-Year Outcomes in Newly Diagnosed Children With Crohn's Disease. Clinical Gastroenterology and Hepatology, 4(9), 1124-1129. https://doi.org/10.1016/j.cgh.2006.05.011