Early Infliximab in Crohn's is associated with decreased intestinal surgery and similar health care costs.

Abstract

Background: Using Infliximab early in Crohn's disease can provide a window of opportunity in children for restoration of growth and achievement of puberty. We aimed to compare clinical outcomes and costs of a retrospective pediatric Crohn's disease (pCD) cohort treated with early use Infliximab (EUI) within 12 months compared with later use Infliximab (LUI). Method(s): Retrospective review of all children with pCD commenced on Infliximab was undertaken in a tertiary Australian pediatric center. Result(s): pCD progressing to Infliximab was identified in 70 children: 38 (54%) in the EUI cohort versus 32 (46%) in the LUI cohort. Intestinal surgery had a higher risk of occurring in EUI when compared with LUI (2 (5%) versus 9 (28%), HR 5.67 (95% CI 1.21-26.38); p =.027). No patients in EUI underwent intestinal surgery post Infliximab commencement compared with 3 (9%) in LUI (p =.09). Escalation of Infliximab in luminal Crohn's disease was not significantly different in EUI when compared with LUI (3 (10.3%) versus 9 (39.1%) (p =.1)). EUI was more frequently used than LUI in 2015-2018 (27 (71%) versus 14 (44%)) p =.029, with the inverse occurring in 2010-2014 (11 (29%) versus 18 (56%)). Hospital admissions per person per year in EUI and LUI were 43 (0.23 visits/person/year) versus 84 (0.67 visits/person/year); IRR 2.51 (95% CI 0.9-7.01); p =.078). Health costs were not significantly different between cohorts. Conclusion(s): EUI in pCD is associated with an increased likelihood of being diagnosed in more recent years, less intestinal surgery and a trend toward decreased hospital admissions than LUI.Copyright © 2021 Informa UK Limited, trading as Taylor & Francis Group.