Accelerated Step-Up Infliximab Use Is Associated with Sustained Primary Response in Pediatric Crohn’s Disease

Buurman, D. J.; Ravikumara, Madhur; Mews, Catherine; Thacker, Kunal; Grover, Zubin

doi:10.1007/s10620-018-4969-8

Cited by 7 publications

(7 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two studies provide evidence for lowering risk of penetrating complications with early biologic treatment, although one study showed that early treatment might not lower risk of stricturing complications . Five studies showed value of early treatment for loss of response, better height, higher PCDAI score, prolonged response rate and sustained primary response . In one observational study outcomes were similar to accelerated step‐up and conventional management .…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

Ungaro

Aggarwal

Topaloglu

et al. 2020

Aliment Pharmacol Ther

View full text Add to dashboard Cite

Background: There is an increasing body of evidence showing that earlier use of biologics improves clinical outcomes in Crohn's disease (CD). Aim:To perform a systematic review and meta-analysis to assess the impact of early biologic use in the treatment of CD. Methods: PubMed and Embase databases were searched for English language papers and conference abstracts published through April 30, 2019. Studies were selected for inclusion if patients initiated biologics within 2 years of a CD diagnosis or if earlier biologics use (top-down) was compared with a conventional step-up strategy. Randomeffects meta-analyses were conducted to compare clinical remission (CR), relapse and endoscopic healing rates between early biologic treatment (<2 years of disease duration or top-down treatment strategy) and late/conventional treatment (biologic use after >2 years of disease duration or conventional step-up treatment strategy).Results: A total of 3069 records were identified, of which 47 references met the selection criteria for systematic review. A total of 18 471 patients were studied, with a median follow-up of 64 weeks (range 10-416). Meta-analysis found that early use of biologics was associated with higher rates of clinical remission (OR 2.10 [95% CI:1.69-2.60], n = 2763, P < 0.00001), lower relapse rates (OR 0.31 [95% CI: 0.14-0.68], n = 596, P = 0.003) and higher mucosal healing rates (OR 2.37 [95% CI: 1.78-3.16], n = 994, P < 0.00001) compared with late/conventional management. Conclusions:Early biologic treatment is associated with improved clinical outcomes in both adult and paediatric CD patients, not only in prospective clinical trials but also in real-world settings.

show abstract

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

Ungaro

Aggarwal

Topaloglu

et al. 2020

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…Although there is rising evidence that early treatment with anti-TNF agents is superior to early immunomodulators [19][20][21][22], the classic step-up approach still remains standard practice in most European centers. This is in part due to local restrictions that dictate when biologics can be initiated but also due to the lack of validated prognostic markers that can identify at diagnosis which patients will progress and require rescue therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Common practice in most European pediatric centers is still a step-up approach where biological therapy is generally introduced after failure of corticosteroids, EEN and conventional immunomodulators. However, there is rising evidence that early treatment with anti-TNF is superior to early immunomodulators [16,[19][20][21][22]. Therefore, in the era where new classes of biologics are entering the market, the place of immunomodulators in the treatment of pediatric IBD is questioned.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcome of immunomodulator use in pediatric patients with inflammatory bowel disease

Hoeve

Hoffman

D’Hoore

et al. 2020

Digestive and Liver Disease

View full text Add to dashboard Cite

“…There are clear benefits of early anti-TNF in children with CD with higher rates of CS-free remission, mucosal healing (MH) and a modest improvement in linear growth. Data on long-term benefits such as intestinal resection or development of complicating disease were lacking up until recently (36)(37)(38).…”

Section: Can Early Aggressive Therapy Prevent Complications In Paediamentioning

confidence: 99%

Predicting and preventing complications in children with inflammatory bowel disease

Grover¹

2019

Transl Pediatr

View full text Add to dashboard Cite

Paediatric-onset inflammatory bowel disease (IBD) is associated with greater disease burden and morbidity compared to adult-onset IBD. Accurate risk prediction for a complicated disease course in childhood onset IBD is essential for making the best treatment choices. Complicating course in IBD is closely linked with choice of therapies and treatment targets. In this review article, we examine risk factors of complicated disease course in children with IBD in the era of increasing use of biologics and tighter treatment targets. We also discuss emerging paediatric data supporting an early intensive approach targeting deeper healing, aiming for remission beyond symptoms with repeat endoscopic examination to make treatment adjustments.

show abstract

Accelerated Step-Up Infliximab Use Is Associated with Sustained Primary Response in Pediatric Crohn’s Disease

Abstract: Early step-up use of IFX in children with CD with inadequate clinical response to conventional therapies leads to sustained primary response over 2 years.

Cited by 7 publications

References 11 publications

Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

Long-term outcome of immunomodulator use in pediatric patients with inflammatory bowel disease

Predicting and preventing complications in children with inflammatory bowel disease

Contact Info

Product

Resources

About