Efficacy of infliximab after loss of response of/intolerance to adalimumab in pediatric Crohn's disease: A retrospective multicenter cohort study of the "GETAID pédiatrique"

BACKGROUND

Infliximab (IFX) and adalimumab (ADA) are recommended for induction and maintenance of remission in pediatric Crohn's disease (CD). ADA is now often used in first line due to its efficacy and tolerability, but a loss of response (LOR) can occur over time. The aim was to assess the efficacy of IFX as second line therapy after LOR or intolerance to ADA in pediatric CD patients at 1 year.

METHODS

We conducted a retrospective and multicenter study in France among the "GETAID pédiatrique" centers between April 2019 and April 2022. CD patients under 18 years old and treated with IFX after ADA failure or intolerance were included. We collected anthropometric, clinical, and biological data at baseline (start of IFX), at 6 and 12 months. Clinical remission was defined by a Weighted Pediatric CD Activity Index (wPCDAI) score less than 12.5 points.

RESULTS

Of the 32 patients included in our study, 27 (84.4%) were still on IFX at 12 months of the switch. Among them, 13 had discontinued ADA because of a LOR, 12 for insufficient response and 2 due to primary nonresponse. At M12, 22 patients were in corticosteroid free clinical remission (68.7%). Under IFX, the wPCDAI decreased over time (47.5 ± 24.1, 16.6 ± 21.2 and 9.7 ± 19.0 at M0, M6 and M12 respectively). The only factor associated with clinical remission at 12 months was absence of perianal disease at the end of the IFX induction.

CONCLUSIONS

IFX is effective in maintaining remission at 1 year in pediatric CD patients experiencing a LOR or intolerance with ADA, and IFX could be an interesting therapeutic choice instead of other biologics in this situation.

Traumatisme crânien de l'enfant : un casse-tête ?

Le traumatisme crânien de l’enfant représente un enjeu majeur de santé publique, tant par sa fréquence que par sa potentielle gravité. À ce jour, nombreux auteurs et recommandations proposent des arbres décisionnels face à l’enfant traumatisé crânien, dans l’objectif de reconnaître rapidement les critères de gravité cliniques et scanographiques faisant suspecter des lésions cérébrales irréversibles. La prise en charge précise du traumatisme crânien grave débute dès la phase pré-hospitalière, par des mesures de neuroprotection efficaces et le contrôle optimal des facteurs d’agression cérébrale secondaire d’origine systémique, en respectant la loi du “tout normal”. Il paraît nécessaire de comprendre les paramètres influençant le débit sanguin cérébral et d’en assurer un monitorage adapté en neuro-réanimation pédiatrique, afin de lutter contre l’hypertension intracrânienne. L’apparition à distance de troubles cognitivo-comportementaux séquellaires rend la surveillance des enfants traumatisés crâniens indispensable sur le long terme.