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CRP normalization during Remicade induction predicts durable response in pediatric IBD
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Normalization of previously elevated C-reactive protein during Remicade induction therapy was strongly associated with durable response at 1 year in pediatric inflammatory bowel disease patients, according to data presented at the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Annual Meeting.
Pediatric gastroenterologists from Massachusetts General Hospital for Children sought to identify predictive factors for durable response to Remicade (infliximab, Janssen) in pediatric patients with IBD, as many children with IBD eventually lose response to this treatment.
“We really set out on this project to give our own patients a strong indication about how successful infliximab can be if they initially respond to it,” Christopher J. Moran, MD, from MassGeneral Hospital for Children, told Healio Gastroenterology. “After looking at multiple factors, we found that the patients who had normalized their C-reactive protein by the start of maintenance infliximab (at week 14) not only stood the best chance of remaining on it a 1 year, but were also more likely to remain on it at 2 years, 3 years, and 5 years.”
Moran and colleagues identified 227 patients aged younger than 21 years (Crohn’s disease, n = 179; ulcerative colitis, n = 46) who completed infliximab induction therapy and were followed for 1 year.
Overall, patients received an average of 17.3 infliximab infusions, average age of disease onset was 13.1 years, 20.8% had A1a disease, 61.6% had A1b disease and infliximab therapy was initiated within a year of diagnosis in 50.2%. Primary response was achieved by 89%, and 77.9% had durable response at 1 year (Crohn’s disease, 79.5%; UC, 71.1%).
They found no association between durable response and baseline CRP elevation, concomitant immunomodulatory use or time between diagnosis and initiation of induction therapy. However, they did find associations between durable response at 1 year and a normal CRP level at week 14 (P = .003), normalization of previously elevated CRP at week 14 (P < 001) and previous immunomodulatory use (P = .039).
The researchers concluded that most children with IBD have a durable response to infliximab at 1 year, and that CRP normalization during induction strongly predicts durable response. – by Adam Leitenberger
Reference:
Moran CJ, et al. Abstract 70. Presented at: North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Annual Meeting; Oct. 8-11, 2015; Washington, D.C.
Disclosures: The researchers report no relevant financial disclosures.