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
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.