Safety and Durability of Accelerated Infliximab Dosing Strategies in Pediatric IBD

Objectives: Infliximab (IFX) is commonly used to treat children with inflammatory bowel disease (IBD). We previously reported that patients with extensive disease started on IFX at a dose of 10 mg/kg had greater treatment durability at year one. The aim of this follow‐up study is to assess the long‐term safety and durability of this dosing strategy in pediatric IBD. Methods: We performed a retrospective single‐center study of pediatric IBD patients started on IFX over a 10‐year period. Results: Two hundred ninety‐one patients were included (mean age = 12.61, 38% female) with a follow‐up range of 0.1–9.7 years from IFX induction. One hundred fifty‐five (53%) were started at a dose of 10 mg/kg. Only 35 patients (12%) discontinued IFX. The median duration of treatment was 2.9 years. Patients with ulcerative colitis (P ≤ 0.01) and patients with extensive disease (P = 0.01) had lower durability, despite a higher starting dose of IFX (P = 0.03). Adverse events (AEs) were observed to occur at a rate of 234 per 1000 patient‐years. Patients with a higher serum IFX trough level (≥20 µg/mL) had a higher rate of AEs (P = 0.01). Use of combination therapy had no impact on risk of AEs (P = 0.78). Conclusions: We observed an excellent IFX treatment durability, with only 12% of patients discontinuing therapy over the observed timeframe. The overall rate of AEs was low, the majority being infusion reactions and dermatologic conditions. Higher IFX dose and serum trough level> 20 µg/mL were associated with higher risk of AEs, the majority being mild and not resulting in cessation of therapy.