Toepassing van infliximab bij kinderen en adolescenten met therapieresistente ziekte van Crohn in Nederland; ervaringen bij 23 patiënten

OBJECTIVE: To describe the clinical experience of infliximab treatment in children and adolescents with refractory Crohn's disease in the Netherlands. DESIGN: Descriptive. METHOD: From November 1998 to February 2002, 23 patients (aged 7-18 years) with refractory Crohn's disease or steroid-dependent Crohn's disease (with or without severe fistulas) were treated with infliximab. Patients were treated with 1-11 infusions, with an average follow-up of 14.5 months after the start of infliximab therapy. RESULTS: Ten patients had refractory Crohn's disease. Four of these showed good long-term response on infliximab treatment (modified 'Paediatric Crohn's disease activity index' (PCDAI) < or = 10 points or growth acceleration after stunting). Twelve patients had Crohn's disease with severe fistulas. Five of these showed good long-term response (closure or non-productiveness of fistulas). One patient had metastatic Crohn's disease in the skin and showed good long-term response. CONCLUSION: Response rates were lower than observed in previous studies. Specifically, a decrease of response was demonstrated after repeated infusion. The treatment frequency should be determined by the increase in complaints rather than using a fixed interval of 8 weeks