Inflammatory Bowel Disease

Discussing the latest advances in Crohn’s disease and ulcerative colitis

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May 23rd, 2014

Infliximab Therapy for Pediatric IBD Patients

By Margaret Shepard, Communications Specialist

Jeanne Tung, M. D., discusses a recent article published in Inflammatory Bowel Diseases about long-term infliximab, also known as Remicade, use for pediatric inflammatory bowel disease (IBD). Remicade was approved for Crohn's disease in 1997 and ulcerative colitis is 2005. This study is important because many parents want to know how long their child will be on Remicade and what the possible side effects will be.

 

The 10-year long study was conducted in the Pediatric Inflammatory Bowel Disease Program at Cedars-Sinai Medical Center in Los Angeles. The researchers looked back at their records for children who were under 21, had received Remicade, and had hospital records for at least one year after receiving Remicade. Based on that criteria, the researchers found 188 patients. 157 patients had Crohn's disease, and 31 had ulcerative colitis. On average, the patients had been on Remicade for 2 to 2.5 years.

About two thirds of the Crohn's disease patients were taking Methotrexate, Azathioprine, or 6-Mercaptopurine in addition Remicade. About 4% of the patients did not respond to Remicade at all. Of the patients that initially responded, 88% were still on Remicade one year later, 80% were on Remicade two years later, and about 72% stayed on Remicade about five years after they started. About 25% of the patients that stayed on Remicade needed a dose increase.

About one third of patients with ulcerative colitis were taking Methotrexate, Azathioprine, or 6-Mercaptopurine in addition to Remicade. 25% of the patients did not respond to Remicade at all. This is a similar result to other studies that show Remicade tends to work better for Crohn's disease than ulcerative colitis. Of the patients who were able to stay on Remicade, 70% of them were able to avoid surgery after one year. 12.9% required a dose increase.

There were other reasons Remicade needed to be stop besides losing response or not responding at all.

  • Several patients developed antibodies or had infusion reactions
  • A few patients developed a rash or joint pain
  • Only one patient had to stop because of repeated infections

No one developed cancer from taking Remicade in this study. One patient developed a disease related to the Epstein-Barr Virus (EBV), the virus that causes mononucleosis.

The researchers at Cedars-Sinai didn't notice an advantage to being on Methotrexate in addition to Remicade. This may be due to being on too low of a dose of Methotrexate or the sample size being too small to notice a difference.

The takeaways of the study are:

  • If you have Crohn's disease and respond to Remicade, you should be able to stay on it for a few years
  • If you have ulcerative colitis, it is less likely you'll respond to Remicade but if it works for you, you should be able to avoid surgery for at least one year
  • Overall, Remicade is safe

Read the full study online here.

For more information on IBD, visit mayoclinic.org/IBD.

Dr. Tung is a pediatric gastroenterologist at Mayo Clinic.

Tags: Cedars-Sinai Medical Center, Clinical Trials, IBD, Inflammatory Bowel Disease Journal, infliximab, Jeanne Tung, pediatric Crohn's disease, pediatrics, Study Findings, ulcerative colitis

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Exhaustedmom
@Exhaustedmom

Posts: 1
Joined: Nov 28, 2015
Posted by @Exhaustedmom, Nov 28, 2015

My 19 yr old son. (Birthday was Thanksgiving) had been on remicaid for little over a year. He’s told Dr. At last 2 appts. He feels its not working. His anal fistulas have not changed and even abcest about 10 days in office before next infusion. His last infusion should have been on 11-10-2015. But occasional fevers sent him home without it. 5 wks. 4 ER visits. A lung Dr. Sent him for yet another EKG. Then back again to AI Dupont. He couldnt breath lay flat and has chest pain that started in 1 spot in his chest. Spread and moved highest fever was 103. When Dr. In ER finally showed us it was pneumonia i broke down crying because alls we were told is he had fluid in between lungs and ribs. Not enough to drain or cause such pain. He still has not recieved his infusion. Im worried because the only Dr hes ever seen for this only looked at his labs and said hes fine. He did not seam to listen to his concerns. Now the Dr. Only said he was aware of his admittance to AI. And we have no idea what to do between Dr. And having these problems. Its not right. As soon as my son started saying he felt like it was not working the Dr seamed to turn a deft ear now using his age to push him out. I was told he could be seen till age 21 for this problem while he had infusions. Does anyone know how this will effect him?

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