Two-year outcomes after exclusive enteral nutrition induction are superior to corticosteroids in pediatric Crohn’s disease treated early with thiopurines

Grover, Zubin and Lewindon, Peter (2015) Two-year outcomes after exclusive enteral nutrition induction are superior to corticosteroids in pediatric Crohn’s disease treated early with thiopurines. Digestive Diseases and Sciences, 60 10: 3069-3074. doi:10.1007/s10620-015-3722-9


Author Grover, Zubin
Lewindon, Peter
Title Two-year outcomes after exclusive enteral nutrition induction are superior to corticosteroids in pediatric Crohn’s disease treated early with thiopurines
Journal name Digestive Diseases and Sciences   Check publisher's open access policy
ISSN 1573-2568
0163-2116
Publication date 2015-06-03
Sub-type Article (original research)
DOI 10.1007/s10620-015-3722-9
Open Access Status Not Open Access
Volume 60
Issue 10
Start page 3069
End page 3074
Total pages 6
Place of publication New York, NY, United States
Publisher Springer New York
Language eng
Abstract Impact of first-line induction therapy on medium-term outcomes in the setting of early thiopurine (TP) use in children with Crohn's disease has not been evaluated, in particular whether choice of exclusive enteral nutrition (EEN) over corticosteroids (CS) for induction impacts clinical outcomes at 12 and 24 months.

In this retrospective study, 89 children from our database with new diagnosis CD and follow-up of at least 2 years following induction with exclusive course of CS or EEN and early, dose-optimized TP (within 6 months from diagnosis) were evaluated. We compared steroid dependency (relapse <3 months of tapering first course CS or inability to wean <10 mg prednisolone), need for IFX, linear growth, and surgical resections over the first 2 years.

Choice of EEN over CS induction was associated with reduced linear growth failure (7 vs. 26%, p = 0.02), CS dependency (7 vs. 43%, p = 0.002), and improved primary sustained response to IFX (86 vs. 68%, p = 0.02). Combined CS/IFX-free remission and surgical resection rates were similar.

In the setting of early TP commencement, EEN induction is superior to CS induction for reducing growth failure, CS dependency, and loss of response to IFX over the first 2 years.
Formatted abstract
Background: Impact of first-line induction therapy on medium-term outcomes in the setting of early thiopurine (TP) use in children with Crohn’s disease has not been evaluated, in particular whether choice of exclusive enteral nutrition (EEN) over corticosteroids (CS) for induction impacts clinical outcomes at 12 and 24 months.

Aims and Methods: In this retrospective study, 89 children from our database with new diagnosis CD and follow-up of at least 2 years following induction with exclusive course of CS or EEN and early, dose-optimized TP (within 6 months from diagnosis) were evaluated. We compared steroid dependency (relapse <3 months of tapering first course CS or inability to wean <10 mg prednisolone), need for IFX, linear growth, and surgical resections over the first 2 years.

Results: Choice of EEN over CS induction was associated with reduced linear growth failure (7 vs. 26 %, p = 0.02), CS dependency (7 vs. 43 %, p = 0.002), and improved primary sustained response to IFX (86 vs. 68 %, p = 0.02). Combined CS/IFX-free remission and surgical resection rates were similar.

Conclusion: In the setting of early TP commencement, EEN induction is superior to CS induction for reducing growth failure, CS dependency, and loss of response to IFX over the first 2 years.
Keyword Crohn’s disease
CS dependent
EEN
Infliximab response
Thiopurines
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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