Earlier Infliximab Initiation Is Associated with Endoscopic Healing in Pediatric Crohn’s Disease

Background/Objectives: This study aimed to identify clinical factors associated with endoscopic healing (EH) in pediatric patients with Crohn’s disease (CD) treated with infliximab (IFX). Methods: We performed a mixed retrospective/prospective registry-based cohort analysis using data from the Childhood & Adolescent Registry of Korean Inflammatory Bowel Disease (CARE-KIDS). Pediatric patients diagnosed with CD before 18 years of age who received IFX and underwent follow-up endoscopy were included. EH was defined as a Simple Endoscopic Score for Crohn’s Disease (SES-CD) < 3. Clinical variables, including the interval from diagnosis to IFX initiation, were evaluated using univariable logistic regression. Results: A total of 150 patients were included (median age at diagnosis, 14.4 years; 66.0% male). EH was present in 85 patients (56.7%) at the first follow-up endoscopy, performed at a median of 1.20 years (IQR, 1.02–1.98) after IFX initiation. There were no significant differences in sex, age at diagnosis, disease location, behavior, perianal involvement, growth status, or laboratory markers between the EH and non-EH groups. However, patients with EH had a shorter disease duration before IFX initiation than those without EH (median 0.19 vs. 0.38 years, p = 0.041). A longer interval from diagnosis to IFX initiation was associated with lower odds of EH (unadjusted OR per one-year increase, 0.21; 95% CI, 0.07–0.58; p = 0.004). Conclusions: Earlier IFX initiation was associated with EH in pediatric CD. These findings are consistent with a potential therapeutic window, although the observational analysis does not establish causality or an optimal treatment initiation cutoff.