In case of failure of exclusive enteral nutrition, corticosteroid and immunomodulator therapies, the initiation of infliximab can be effective in paediatric patients diagnosed with moderate-to-severe Crohn’s disease recently.

This study compared if beginning first-line infliximab (IFX) is more effective to accomplish and sustain remission than the standard treatment.

Children aged 3–17 years (weighted Paediatric CD Activity Index score (wPCDAI) greater than 40) with newly diagnosed Crohn’s disease were included. They were allocated to groups to receive five infusions of IFX 5 mg/kg at specified weeks first-line IFX, or exclusive enteral nutrition or standard treatment as prednisolone given orally (1 mg/kg, maximum 40 mg). Primary outcome was clinical remission on azathioprine.

On the whole, 100 patients were divided into first-line IFX group and standard group (50 patients in each). Four patients did not obtain treatment according to protocol. Many patients in the FL-IFX group achieved clinical and endoscopic remission as compared to standard treatment at week 10 (Table 1):

On the other hand, 19 patients in the first-line IFX group (out of 46 patients) were in clinical remission on azathioprine alone without the requirement of treatment escalation as opposed to 7 patients in the standard group (out of 48 patients).

The first-line IFX was found to be superior than standard treatment in attaining short-term clinical and endoscopic remission, with a higher probability of clinical remission maintenance at week 52 on azathioprine alone.