ABSTRACT
Tumour necrosis factor alpha plays a central role in chronic intestinal inflammation of Crohn's disease. Targeting this cytokine with the chimeric monoclonal antibody infliximab has emerged as an effective form of therapy in adult Crohn's disease patients. Fifteen consecutive children with medically refractory Crohn's disease were enrolled in a prospective, open-label trial of a single, 5 mg/kg infliximab intravenous infusion. Medically refractory disease’ was defined as an inability to taper steroids, lack of response to immunomodulator therapy over four months and active disease as measured by the Pediatric Crohn's Disease Activity Index. Crohn's disease should benefit from advanced understanding of genetic and epigenetic influences as well as advances in understanding of the immune system and metabolome. Cell-adhesion and intracellular signalling pathways are targets for a host of new monoclonal agents. The challenge for the future will be recognising the individual nuances of each individual case in order to select truly personalised therapy.
