Factors associated with time to clinical remission in pediatric luminal Crohn's disease: A retrospective cohort study

Sassine, Samuel; Zekhnine, S Fadela; Qaddouri, Marwa; Djani, L; Cambron‐Asselin, Christine; Savoie-Robichaud, M; Lin, Yi; Grzywacz, Kelly; Groleau, Véronique; Dirks, M; Drouin, Éric; Halac, Ugur; Marchand, Valérie; Girard, Chloé; Courbette, Olivier; Patey, Natalie; Soglio, Dorothée Dal; Deslandres, Colette; Jantchou, P

doi:10.1002/jgh3.12684

Cited by 4 publications

(3 citation statements)

References 43 publications

(64 reference statements)

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“…To obtain early MH and maintain sustained MH, patients with an SES-CD greater than 11.5 at baseline should be treated more aggressively with biologics. Because some more severe patients could combine IFX with EEN to induce remission, it has been reported that the combination of EEN and TNFα inhibitors was associated with faster clinical remission ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

The SES-CD Could Be a Predictor of Short- and Long-Term Mucosal Healing After Exclusive Enteral Nutrition in Pediatric Crohn’s Disease Patients

Tang

Shi

et al. 2022

Front. Pediatr.

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AimsTo explore the predictors of mucosal healing (MH) for short- and long-term after exclusive enteral nutrition (EEN) in pediatric Crohn’s disease (CD) patients.MethodsA retrospective analysis was performed for newly diagnosed active CD patients admitted to our center from January 2017 to 30 December 2020, who were treated with EEN for induction therapy with a minimum of 12 months of follow-up post-EEN. According to the simple endoscopic score for CD (SES-CD), at 1-year post-EEN, 17 patients with an SES-CD < 3 were classified into the sustained MH group (sMH), and 33 patients with an SES-CD ≥ 3 were classified into the sustained non-MH group (sNMH). Statistical methods were used to compare the differences between the two groups and explore the predictors of MH at the end of EEN and 1-year post-EEN.ResultsThe SES-CD in the sMH group was lower than that in the sNMH group both at baseline and the end of EEN [sMH vs. sNMH: 8.7 ± 1.2 vs. 16.2 ± 1.0, respectively, p < 0.001 at baseline; 1.0 (3.5) vs. 4.0 (2.0), respectively, p < 0.01 at the end of EEN]. The weighted Pediatric Crohn’s Disease Activity Index and erythrocyte sedimentation rate in the sMH group were lower than those in the sNMH group at baseline (both p < 0.05), but showed no difference at the end of EEN. From baseline to 1-year post-EEN, compared with patients in the sNMH group, there were more patients classified with L1 in the sMH group at each time point (all p < 0.001) and fewer patients classified with L3 in the sMH group at baseline and 1-year post-EEN. After EEN, fewer patients received infliximab and had a longer exposure time to infliximab in the sMH group than in the sNMH group. Only the SES-CD at baseline was negatively associated with MH at the end of EEN (OR = 1.40 95% CI = 1.12–1.67, p = 0.00) and 1-year post-EEN (OR = 1.33, 95% CI = 1.12–1.58, p = 0.001), and the cut off value was 11.5.ConclusionThe SES-CD could predict both short- and long-term MH for EEN. Patients with an SES-CD < 11.5 had a high probability of reaching MH by EEN-inducing therapy and maintaining sustained MH at 1-year post-EEN. Patients with an SES-CD greater than 11.5 at baseline should be treated more aggressively with biologics.

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Section: Discussionmentioning

confidence: 99%

The SES-CD Could Be a Predictor of Short- and Long-Term Mucosal Healing After Exclusive Enteral Nutrition in Pediatric Crohn’s Disease Patients

Tang

Shi

et al. 2022

Front. Pediatr.

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“…A significant bias must be considered because patients who are slow to go into the first remission are followed afterward for a shorter period in a pediatric setting before their transfer to adult care. However, we have demonstrated in a past study that patients with high levels of inflammatory markers (CRP, FC, and erythrocyte sedimentation rate) reached clinical remission faster (29). In this study, patients in clinical remission with increased CRP and FC levels were at a greater risk of relapse, which could explain the association between shorter time to remission and higher risk of relapse.…”

Section: Discussionmentioning

confidence: 91%

“…Clinical variables at diagnosis included age; patient's sex; weight, height, and body mass index z-scores; PCDAI (24); and Paris classification of CD, clinical symptoms, extraintestinal manifestations, and time to the first clinical remission (either continuously in days or categorized with a cutoff level of 12 weeks based on a study that demonstrated that being in clinical remission at 12 weeks after induction was predictive of steroid-free remission at 1 year (28)). We defined clinical remission as the resolution of clinical symptoms, that is, defined by a sPCDAI score of <10 (29).…”

Section: Methodsmentioning

confidence: 99%

Risk Factors of Clinical Relapses in Pediatric Luminal Crohn's Disease: A Retrospective Cohort Study

et al. 2022

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INTRODUCTION:There is currently little knowledge on factors associated with the relapse of Crohn's disease (CD) in children. The aims of this study were to describe the risk factors associated with relapse in pediatric CD and the changes in the relapse rate over the past decade.METHODS:Patients younger than 18 years and diagnosed between 2009 and 2019 were included in this retrospective cohort study. Clinical, endoscopic, histological, and laboratory data, as well as induction and maintenance treatments, were collected from the medical records. Survival analyses and Cox regression models were used to assess the impact of these risk factors on relapse.RESULTS:Six hundred thirty-nine patients were included. There was a decrease in the clinical relapse rate over the past decade: 70.9% of the patients diagnosed between 2009 and 2014 relapsed as compared with 49.1% of the patients diagnosed between 2015 and 2019 (P < 0.0001). The following variables were associated with clinical relapse: female sex (adjusted hazard ratio [aHR] = 1.52, P = 0.0007), exposure to oral 5-ASA (aHR = 1.44, P = 0.04), use of immunomodulatory agents compared with tumor necrosis factor-alpha inhibitors (methotrexate aHR = 1.73, P = 0.003; thiopurines aHR = 1.63, P = 0.002), presence of granulomas (aHR = 1.34, P = 0.02) and increased eosinophils on intestinal biopsies (aHR = 1.36, P = 0.02), high levels of C-reactive protein (aHR = 1.01, P < 0.0001) and fecal calprotectin (aHR = 1.08, P < 0.0001), and low serum infliximab levels (aHR = 2.32, P = 0.001).DISCUSSION:Relapse of pediatric CD has decreased in the past decade. The risk of relapse is significantly associated with clinical, endoscopic, histological, and laboratory variables and treatment strategies.

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The State of Clinical Trials in Pediatric Inflammatory Bowel Disease

Hyams

Russell²

2023

Gastroenterology Clinics of North America

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Factors associated with time to clinical remission in pediatric luminal Crohn's disease: A retrospective cohort study

Cited by 4 publications

References 43 publications

The SES-CD Could Be a Predictor of Short- and Long-Term Mucosal Healing After Exclusive Enteral Nutrition in Pediatric Crohn’s Disease Patients

The SES-CD Could Be a Predictor of Short- and Long-Term Mucosal Healing After Exclusive Enteral Nutrition in Pediatric Crohn’s Disease Patients

Risk Factors of Clinical Relapses in Pediatric Luminal Crohn's Disease: A Retrospective Cohort Study

The State of Clinical Trials in Pediatric Inflammatory Bowel Disease

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