Evaluation of exclusive enteral nutrition and corticosteroid induction treatment in new-onset moderate-to-severe luminal paediatric Crohn's disease.

Autor: Jongsma MME; Department of Pediatric Gastroenterology, Erasmus Medical Centre-Sophia Children's Hospital, Room SP-2430, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands., Vuijk SA; Department of Pediatric Gastroenterology, Erasmus Medical Centre-Sophia Children's Hospital, Room SP-2430, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands., Cozijnsen MA; Department of Pediatric Gastroenterology, Erasmus Medical Centre-Sophia Children's Hospital, Room SP-2430, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands., van Pieterson M; Department of Pediatric Gastroenterology, Erasmus Medical Centre-Sophia Children's Hospital, Room SP-2430, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands., Norbruis OF; Department of Pediatric Gastroenterology, Isala Hospital, Zwolle, Netherlands., Groeneweg M; Department of Pediatric Gastroenterology, Maasstad Hospital, Rotterdam, Netherlands., Wolters VM; Department of Pediatric Gastroenterology, Utrecht Medical Centre-Wilhelmina Children's Hospital, Utrecht, Netherlands., van Wering HM; Department of Pediatric Gastroenterology, Amphia Hospital, Breda, Netherlands., Hojsak I; Referral Centre for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia., Kolho KL; Tampere University Hospital and University of Tampere, Tampere, Finland.; Children's Hospital, University of Helsinki, Helsinki, Finland., van Wijk MP; Department of Pediatric Gastroenterology, Amsterdam UMC-Emma Children's Hospital, VU University, Amsterdam, Netherlands., Teklenburg-Roord STA; Department of Pediatric Gastroenterology, Isala Hospital, Zwolle, Netherlands., de Meij TGJ; Department of Pediatric Gastroenterology, Amsterdam UMC-Emma Children's Hospital, VU University, Amsterdam, Netherlands., Escher JC; Department of Pediatric Gastroenterology, Erasmus Medical Centre-Sophia Children's Hospital, Room SP-2430, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands., de Ridder L; Department of Pediatric Gastroenterology, Erasmus Medical Centre-Sophia Children's Hospital, Room SP-2430, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands. l.deridder@erasmusmc.nl.
Jazyk: angličtina
Zdroj: European journal of pediatrics [Eur J Pediatr] 2022 Aug; Vol. 181 (8), pp. 3055-3065. Date of Electronic Publication: 2022 Jun 08.
DOI: 10.1007/s00431-022-04496-7
Abstrakt: To induce remission in luminal paediatric Crohn's disease (CD), the ESPGHAN/ECCO guideline recommends treatment with exclusive enteral nutrition (EEN) or oral corticosteroids. In newly diagnosed moderate-to-severe paediatric CD patients, we determined the proportion of patients in which EEN or corticosteroids induced remission and maintained remission on azathioprine monotherapy. We included patients from the "TISKids" study assigned to the conventional treatment arm. Patients were aged 3-17 years and had new-onset, untreated luminal CD with weighted paediatric CD activity index (wPCDAI) > 40. Induction treatment consisted of EEN or oral corticosteroids; all received azathioprine maintenance treatment from start of treatment. The primary outcome of this study was endoscopic remission defined as a SES-CD score < 3 without treatment escalation at week 10. Secondary outcomes included proportion of patients without treatment escalation at week 52. In total, 27/47 patients received EEN and 20/47 corticosteroids. At baseline, patient demographics and several inflammation parameters were similar between the two treatment groups. At 10 weeks, clinical remission rates were 7/23 (30%) for EEN and 7/19 (37%) for corticosteroids (p = 0.661). Twenty-nine of 47 consented to endoscopy at 10 weeks, showing endoscopic remission rates without treatment escalation in 2/16 (13%) of EEN-treated patients and in 1/13 (8%) of corticosteroid-treated patients (p = 1.00). At week 52, 23/27 (85%) EEN-treated patients received treatment escalation (median 14 weeks) and 13/20 (65%) corticosteroid-treated patients (median 27 weeks), p = 0.070.Conclusion: In children with moderate-to-severe newly diagnosed CD, induction treatment with EEN or CS regularly is insufficient to achieve endoscopic remission without treatment escalation at week 10. Trial registration number: NCT02517684 What is Known: • Endoscopic remission is associated with a low risk of disease progression. • FL-IFX was superior to conventional treatment in achieving and maintaining remission in paediatric patients with moderate-to-severe CD the first year from diagnosis. What is New: • In children with newly diagnosed moderate-to-severe CD, clinical remission rates and endoscopic remission rates without treatment escalation at week 10 were 30% and 13% after EEN and 37% and 8% after corticosteroid induction treatment. • The current treatment target was often not achieved by either EEN or corticosteroid induction treatment after bridging to azathioprine.
(© 2022. The Author(s).)
Databáze: MEDLINE
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