TY - JOUR
T1 - Corticosteroid Therapy in the Age of Infliximab
T2 - Acute and 1-Year Outcomes in Newly Diagnosed Children With Crohn's Disease
AU - Markowitz, James
AU - Hyams, Jeffrey
AU - Mack, David
AU - LeLeiko, Neal
AU - Evans, Jonathan
AU - Kugathasan, Subra
AU - Pfefferkorn, Marian
AU - Mezoff, Adam
AU - Rosh, Joel
AU - Tolia, Vasundhara
AU - Otley, Anthony
AU - Griffiths, Anne
AU - Moyer, M. Susan
AU - Oliva-Hemker, Maria
AU - Wyllie, Robert
AU - Rothbaum, Robert
AU - Bousvaros, Athos
AU - Del Rosario, J. Fernando
AU - Hale, Sandra
AU - Lerer, Trudy
N1 - Funding Information:
Supported by grants from Centocor, Inc. (Malvern, PA), AstraZeneca (Wilmington, DE), Reach Out for Youth With Ileitis and Colitis (Melville, NY), and the collaborating institutions. The operational expenses for the Registry Data Center are supported by grants from Centocor (Horsham, PA), AstraZeneca (Wilmington, DE), and Reach Out for Youth with Ileitis and Colitis (Melville, NY), and from grants from the participating centers. Vasundhara Tolia has received grants, honoraria, and/or consultancy fees from Centocor. Drs Markowitz, Hyams, and Rosh have received honoraria and/or consultancy fees from Prometheus Labs. James Markowitz has received research support from and has served as a Consultant to Centocor. Jeffrey Hyams has received research support from Centocor, and has served as a Consultant to Centocor, Abbott, and ELAN. Subra Kugathasan participated as a Consultant (advisory panel in designing clinical trials) for Centocor and Abbott. Joel Rosh has received research grant support from Proctor and Gamble.
Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2006/9
Y1 - 2006/9
N2 - 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.
AB - 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.
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U2 - 10.1016/j.cgh.2006.05.011
DO - 10.1016/j.cgh.2006.05.011
M3 - Article
C2 - 16861053
AN - SCOPUS:33748147712
VL - 4
SP - 1124
EP - 1129
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
SN - 1542-3565
IS - 9
ER -