Objective: To evaluate the efficacy of infliximab treatment in children and adolescents with ulcerative colitis (UC) defined as short and long-term clinical response and surgical avoidance.

Background: Infliximab has been found to be effective at improving clinical symptoms, sparing steroid use, and inducing remission in children with medically refractory Crohn's disease. Several retrospective studies in children have shown clinical improvement with colectomy avoidance, but the numbers have been small.

Methods: Medical records of all patients with steroid-resistant or dependent UC who received infliximab 5 to 10 mg/kg in a 36-month period at Children's Hospital and Regional Medical Center, Seattle, Washington were reviewed. Response to the medication was defined by posttreatment recategorization into Trulove and Witts "mild" category or better. The duration of response was defined as time between infusion and clinical relapse or colectomy.

Results: Forty children and adolescents aged 2 to 20 years, received infliximab during the study period. Duration of follow-up ranged from 1 to 36 months with a median of 19 months. Four patients were lost to follow-up. Seventy percent of subjects responded to infliximab. Infliximab responders proceeded to surgery less frequently than nonresponders (P<0.001). No laboratory variables correlated with response. Infliximab was well tolerated.

Conclusions: Most children and adolescents with steroid-resistant or dependent UC respond to infliximab with clinical improvement. Response to infliximab also delays and may prevent need for surgery. Laboratory and clinical indicators do not predict response. Infliximab has a role in clinical improvement and surgery avoidance in pediatric patients with UC.