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Infliximab bests conventional treatment to achieve Crohn's disease remission in kids: BMJ
Netherlands: First-line infliximab (FL-IFX) is more effective than conventional treatment in achieving and maintaining remission in pediatric patients with newly diagnosed moderate-to-severe Crohn's disease (CD), finds a recent study in the BMJ journal Gut. Maria M E Jongsma,
In newly diagnosed paediatric patients with moderate-to-severe CD, infliximab (IFX) is initiated once exclusive enteral nutrition (EEN), corticosteroid and immunomodulator therapies have failed. Maria M E Jongsma, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands, and colleagues aimed to investigate whether starting first-line IFX (FL-IFX) is more effective to achieve and maintain remission than conventional treatment.
The multicentre open-label randomised controlled trial included 100 untreated patients with a new diagnosis of CD (3–17 years old, weighted Paediatric CD Activity Index score (wPCDAI) >40). They were assigned to groups that received five infusions of 5 mg/kg IFX at weeks 0, 2, 6, 14 and 22 (FL-IFX; n=50) or EEN or oral prednisolone (1 mg/kg, maximum 40 mg) (conventional; n=50). Four patients did not receive treatment as per protocol.
The primary outcome was clinical remission on azathioprine, defined as a wPCDAI <12.5 at week 52, without need for treatment escalation, using intention-to-treat analysis.
Key findings of the study include:
- At week 10, a higher proportion of patients in the FL-IFX group than in the conventional group achieved clinical (59% vs 34%, respectively) and endoscopic remission (59% vs 17%, respectively).
- At week 52, the proportion of patients in clinical remission was not significantly different.
- 19/46 (41%) patients in the FL-IFX group were in clinical remission on azathioprine monotherapy without need for treatment escalation vs 7/48 (15%) in the conventional group.
"FL-IFX was superior to conventional treatment in achieving short-term clinical and endoscopic remission, and had greater likelihood of maintaining clinical remission at week 52 on azathioprine monotherapy," wrote the authors.
The study titled, "First-line treatment with infliximab versus conventional treatment in children with newly diagnosed moderate-to-severe Crohn's disease: an open-label multicentre randomised controlled trial," is published in the BMJ journal Gut.
DOI: https://gut.bmj.com/content/early/2020/12/31/gutjnl-2020-322339
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751