Long-term Outcomes With Infliximab Treatment in Children With Crohnʼs Disease at a Single Centre
Bibliographic record
Abstract
Infliximab is highly effective in inducing clinical response and remission in luminal Crohn's disease (CD) in children (Hyams, 2007), but pediatric data concerning long-term durability of response are limited. We reviewed the efficacy of infliximab induction and regularly scheduled maintenance treatment in achieving short- and long-term clinical remission, normal linear growth and intestinal healing in a single-center cohort. From 2000 to 2011 at SickKids Hospital, Toronto, 195 children (63% male; median age 14.0 yrs, IQR 12.3-15.6) with intestinal inflammatory CD (20% L1; 17% L2; 63% L3) received infliximab 3-dose induction (5 mg/kg/dose at weeks 0, 2, 6). Median duration of diagnosed CD at initiation was 19.9 mos (range 0.3-136.8). Responders continued on regularly scheduled maintenance treatment +/− immunomodulator (IM). Patient health records were retrospectively reviewed to extract at 6 mos and annually thereafter: physician global assessment (PGA) of continued response/remission versus loss of response, PCDAI, linear growth, re-evaluation colonoscopic data and serum levels of infliximab and antibodies. Durability of response was calculated using a Kaplan-Meier Survival Curve. Pearson's chi-square was used to assess the influence of maintenance regimen (monotherapy versus combination) on likelihood of secondary loss of response (LoR). Among the 195 patients treated, rates of clinical response (judged by PGA) and remission (judged by PGA and PCDAI/= 1 dose escalation. In subjects with LoR, antibodies to Infliximab (ATI) were positive in 85%, absent but with undetectable drug levels in 10%, and inconclusive in 5%. Concurrent IM use (104/180 responders) did not significantly alter LoR, ATI or need for dose escalation. Linear growth data were available for 95% of the cohort. Overall the median height z-score fell from −0.57 at diagnosis to −0.8 at the initiation of Infliximab. Long-term data for patients with growth potential (Tanner 1 or 2 at initiation of infliximab) and at least 3 years of follow-up are shown in Table. These long-term data support the effectiveness of Infliximab in achieving response and improved growth parameters in patients with luminal Crohn's disease. Most secondary LoR was associated with ATI formation. Concurrent IM use did not alter LoR.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".