Document Detail


Corticosteroid therapy in the age of infliximab: acute and 1-year outcomes in newly diagnosed children with Crohn's disease.
MedLine Citation:
PMID:  16861053     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2006-07-24
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  4     ISSN:  1542-3565     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-09-11     Completed Date:  2006-11-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1124-9     Citation Subset:  IM    
Affiliation:
North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA. jmarkowi@nshs.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenal Cortex Hormones / administration & dosage*
Anti-Inflammatory Agents / administration & dosage*
Antibodies, Monoclonal / administration & dosage*
Canada
Child
Child, Preschool
Crohn Disease / drug therapy*
Drug Administration Schedule
Female
Follow-Up Studies
Humans
Male
Prospective Studies
Registries
Treatment Outcome
United States
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Anti-Inflammatory Agents; 0/Antibodies, Monoclonal; 0/infliximab
Comments/Corrections
Comment In:
Clin Gastroenterol Hepatol. 2006 Sep;4(9):1094-6   [PMID:  16901767 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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