Efficacy and Safety of Top-down Therapy in Pediatric Crohn's Disease
Pediatric Crohn's Disease
About this trial
This is an interventional treatment trial for Pediatric Crohn's Disease focused on measuring Pediatric Crohn's disease, Biologics, Immunomodulators, Top-down, step-up
Eligibility Criteria
Inclusion Criteria
- diagnosis of CD,
- PCDAI>30,
- duration of disease less than 1 yr from the time of diagnosis (early CD).
Exclusion Criteria:
- any prior treatment with immunosuppressive agents (AZA/6-MP, methotrexate, cyclosporine) or anti-TNFα,
- stenosing CD,
- pre-existing systemic disease,
- hepatic or renal dysfunction,
- systemic infection,
- suspected pregnancy,
- history of active or past tuberculosis,
- contraindication to steroid therapy
Sites / Locations
- Pediatric Gastroenterology and Liver Unit
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Top-down
Step-up
patients randomized on top-down arm will receive an induction regimen of three consecutive i.v. infusions of infliximab (Remicade, 5 mg/kg) at weeks 0, 2, and 6 plus azathioprine (2 mg/Kg per os/day). During maintaining phase, patients will receive subsequent infusions of infliximab (5 mg/kg every 8 weeks), starting 8 weeks after the end of the induction phase (week 14). At 12 motnhs patients will stop azathioprine and continue infliximab (5 mg/kg every 8 weeks)
Patients randomized on Step-up arm will receive methylprednisolone (1-2 mg/Kg/day per os. for 2 weeks then tapering of 5 mg/week then stop) plus azathioprine (2 mg/Kg/die per os/day). Disease recurrences under azathioprine will be treated with steroid courses (methylprednisolone 1-2 mg/Kg/day per os. for 2 weeks then tapering of 5 mg/week then stop).