Effect of infliximab 'Top-down' therapy on weight gain in pediatric Crohn's disease

This retrospective-medical-record review was conducted to evaluate effect of infliximab therapy, particularly with a 'top-down' strategy, on the nutritional parameters of children with Crohn's disease (CD). 42 patients who were diagnosed with Crohn's disease at the Pediatric Gastroenterology center of a tertiary care teaching hospital and achieved remission at two months and one year after beginning of treatment were divided into four subgroups according to the treatment regimen; 'azathioprine' group (n = 11), 'steroid' group (n = 11), infliximab 'topdown' group (n = 11) and 'step-up' group (n = 9). Weight, height, and serum albumin were measured at diagnosis, and then at two months and one year after the initiation of treatment. At 2 months, the Z-score increment for weight was highest in the 'steroid' group, followed by the 'top-down', 'step-up', and 'azathioprine' groups. At one year, the Z-score increment was highest in 'top-down' group, followed by 'steroid', 'azathioprine', and 'step-up' group. There were no significant differences between the four groups in Z-score increment for height and serum albumin during the study period. The 'top-down' infliximab treatment resulted in superior outcome for weight gain, compared to the 'step-up' therapy and other treatment regimens.