Long-term Outcome of Early Combined Immunosuppression Versus Conventional Management in Newly Diagnosed Crohn’s Disease

Hoekman, Daniël R.; Stibbe, Judith A; Baert, Filip; Caenepeel, Philip; Vergauwe, Philippe; Vos, Martine De; Hommes, Daniël W.; Benninga, Marc A.; Vermeire, Séverine; D’Haens, Geert R.; Club, North-Holland Gut

doi:10.1093/ecco-jcc/jjy014

Cited by 41 publications

(45 citation statements)

References 25 publications

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“…In adult patients, a lower hospitalization rate was observed during eight years (96 months) of follow-up (3). An endoscopic substudy of a Step-up/Topdown trial on 49 pediatric patients did not nd a difference in the time to the rst CD-related hospitalization (P = 0.67) (6), which is in line with our results. It has been shown in adult patients with CD that MH is linked to a lower risk of surgical resection (3).…”

Section: Discussionsupporting

confidence: 90%

“…It has been shown in adult patients with CD that MH is associated with a lower risk of surgical resection, lower hospitalization rate, decreased risk of relapse, and prolonged steroid-free remission (2)(3)(4)(5). However, some recent pediatric data indicate no bene t of MH on CD-related hospitalizations and surgery (6). More extensive pediatric data about MH and longterm outcome are still sparse.…”

Section: Introductionmentioning

confidence: 99%

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Mucosal healing is not associated with better outcome during seven years of follow-up in pediatric patients with Crohn's disease

Melek

Štanclová

Dědek

et al. 2020

Preprint

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Background Mucosal healing (MH) has become a perspective treatment target in patients with Crohn’s disease (CD). Data about the impact of MH on long-term outcome in pediatric patients are still scarce. Methods 76 pediatric patients with CD were evaluated retrospectively (2000–2015) in a tertiary care center. Based on MH achievement, they were divided into two groups (MH, n = 17 and No MH, n = 59). The primary endpoint was to assess the association of MH and the need for CD-related hospitalizations or surgery in pediatric patients with CD. Results The number of hospitalized patients was 24% in the MH group and 42% in the No MH group, P = 0.26. The total number of CD-related hospitalizations was not significant between the MH group and the No MH group (5 vs. 41, P = 0.15). The time to the first hospitalization was 24 months in MH and 21 months in No MH, p > 0.99. 24% patients in the MH group and 39% patients in the No MH group underwent CD-related operation, P = 0.39. Time to the first operation was 43 months for MH and 19 months for the No MH group, P = 0.13. The follow-up period was 91 months in the MH group and 80 months in the No MH group, P = 0.74. The use of infliximab was positively associated with MH, P = 0.002. Conclusions MH was not associated with fewer CD-related hospitalizations or operations in pediatric patients with CD during seven years of follow-up.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Mucosal healing is not associated with better outcome during seven years of follow-up in pediatric patients with Crohn's disease

Melek

Štanclová

Dědek

et al. 2020

Preprint

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“…Previous studies have reported that biologics are beneficial to growth (i.e., height and weight), especially in adolescent patients with CD [891314]. However, their effect on reducing the rate of surgical intervention remains debatable [151617]. Therefore, this study aimed to analyze the effects of biologics on growth and prognosis related to surgery in children and adolescents with CD.…”

Section: Introductionmentioning

confidence: 99%

Use of Anti-TNF Alpha Blockers Can Reduce Operation Rate and Lead to Growth Gain in Pediatric Crohn's Disease

Woo

Cho

Sohn

et al. 2019

Pediatr Gastroenterol Hepatol Nutr

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Purpose Pediatric Crohn's disease (CD) is directly related to growth and has a high probability of requiring surgical intervention(s); therefore, more active treatment for CD is required for children. This study investigated the impact of biologics on growth and disease course associated with surgery. Methods This was a retrospective cohort study involving patients diagnosed with CD at the Seoul National University Children's Hospital (Seoul, Korea) between January 2006 and October 2017. The aim was to determine the characteristics of pediatric patients with CD and whether biologics affected growth and the surgical disease course. Results Among patients who underwent surgery for CD, the mean number of operations per patient was 1.89. The mean time from initial diagnosis to surgery was 19.3 months. The most common procedure was fistulectomy (34%), followed by incision and drainage (25%). In all patients, the use of biologics increased the height ( p =0.002) and body mass index (BMI) ( p =0.005). Among patients who underwent surgery, height ( p =0.004) and BMI ( p =0.048) were increased in the group using biologics. Patients who used biologics exhibited a low operation rate only within 2 years after diagnosis, with no differences thereafter ( p =0.027). Conclusion Although biologics could not mitigate the operation rate in pediatric patients who underwent surgery for CD, biological therapy delayed disease progression within 2 years of disease onset. Additionally, biologics conferred growth and BMI benefits in this window period. Therefore, it may be helpful to use biologics for optimal growth in pediatric patients with a high probability of undergoing future surgery.

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“…This finding may be related to an inadequate statistical power resulting from the small number of patients with hospitalizations (≥3 times). Controversially, a retrospective study of 252 CD patients in Europe demonstrated that MH at 2 years after treatment was not associated with any unfavorable long-term outcome, including surgery, hospitalization, and a new fistula (24). Because unfavorable events might occur within 2 years, this result would have been more convincing if an accurate assessment of MH before adverse events was performed during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Mucosal Healing Is Associated With the Reduced Disabling Disease in Crohn's Disease

Huang

Ben‐Horin

et al. 2019

Clin Transl Gastroenterol

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OBJECTIVES: Mucosal healing (MH) is the goal of the “treat to target” strategy in Crohn's disease (CD), which seeks to prevent disability. However, evidence is limited regarding whether achieving MH can reduce disability in CD. We aimed to estimate the probability of disabling disease and to investigate the association between MH and disabling disease in CD. METHODS: This was a retrospective case-control study of 319 consecutive CD patients. The primary outcome was disabling disease occurrence (defined as surgery, hospitalizations, steroid dependency, or disease complications). The secondary endpoint was disabling disease recurrence. The Kaplan-Meier method and Cox proportional hazards model were used to calculate cumulative rates and for multivariate analysis, respectively. RESULTS: Of 319 CD patients (median follow-up time: 42.4 months, interquartile range: 24.7–60.0 months), 105 (32.9%) progressed to disabling disease and 20 (6.3%) had the recurrence of disabling disease. The cumulative rates of disabling disease were 11.3%, 30.2%, and 44.9% at 1, 3, and 5 years, respectively, after diagnosis. MH was associated with a significantly lower frequency of surgery, new penetrating event, and new stenosis ( P = 0.004, P = 0.001, P = 0.002, respectively). Univariate and multivariate analyses revealed that MH was an independent protective factor of disabling disease occurrence (hazard ratio: 0.166, 95% confidence interval: 0.084–0.329). CONCLUSIONS: Disabling disease was common in Chinese CD patients and increased during follow-up. Moreover, MH was significantly associated with a reduced occurrence of disabling disease in CD.

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Long-term Outcome of Early Combined Immunosuppression Versus Conventional Management in Newly Diagnosed Crohn’s Disease

Cited by 41 publications

References 25 publications

Mucosal healing is not associated with better outcome during seven years of follow-up in pediatric patients with Crohn's disease

Mucosal healing is not associated with better outcome during seven years of follow-up in pediatric patients with Crohn's disease

Use of Anti-TNF Alpha Blockers Can Reduce Operation Rate and Lead to Growth Gain in Pediatric Crohn's Disease

Mucosal Healing Is Associated With the Reduced Disabling Disease in Crohn's Disease

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