Infliximab therapy in children with Crohn’s disease: a one‐year evaluation of efficacy comparing ‘top‐down’ and ‘step‐up’ strategies

Abstract

The aim of this study was to evaluate the efficacy of 'top-down' regimens for the treatment of paediatric Crohn's disease (CD) and to compare it with the effects of 'step-up' treatment. We evaluated patients treated with 'top-down' and 'step-up' regimens at 8 weeks after the initiation of treatment, with 1 year of follow-up. Of the 29 patients who received infliximab, 11 cases refractory to conventional therapy were categorized as the 'step-up' group; and 18 cases, with moderate to severe CD, were categorized as the 'top-down' group. Treatment efficacy was assessed by Pediatric Crohn's Disease Activity Index (PCDAI) scores. At 8 weeks, remission was achieved in three of 11 patients in the 'step-up' group and 16 of 18 patients in the 'top-down' group. At 1 year, remission was maintained in five of 11 patients and in 15 of 18 patients, in the 'step-up' and 'top-down' groups, respectively. The serum albumin level, erythrocyte sedimentation rate, PCDAI score and perianal fistula status demonstrated significant improvement in the 'top-down' group. In paediatric patients with CD, the infliximab 'top-down' strategy resulted in superior outcomes when compared to the 'step-up' strategy for inducing and maintaining remission at 8 weeks and 1 year posttreatment.