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Time to Relapse in Children with Crohn’s Disease Treated with Azathioprine and Nutritional Therapy or Corticosteroids

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Abstract

Background

The duration of remission has been shown to be longer in patients initially treated with exclusive enteral nutrition (EEN) compared to corticosteroids (CS). However, no published studies required concurrent immunomodulator [6-mercaptopurine or azathioprine (AZA)] use at the time of diagnosis.

Aims

The aims of this retrospective study were to compare the duration of remission between patients initially treated with AZA in combination with CS or EEN and identify predictors of early relapse in these patients.

Methods

Data from 65 newly diagnosed children with CD in clinical remission on either EEN or CS and commencing AZA at diagnosis were included. We compared duration of remission using physician global assessment and carried out Cox regression analysis to identify predictors of early relapse. Patients were followed up to the time of first relapse or for at least 12 months.

Results

There were no differences in the duration of remission between patients initially treated with EEN or CS (p = 0.978). We identified younger age at diagnosis [hazard ratio (HR) 0.87, 95 CI 0.78–0.98, p = 0.016], lower height Z score at diagnosis (HR 0.61, 95 CI 0.44–0.85, p = 0.003), involvement of the upper gastrointestinal tract (HR 2.69, 95 CI 1.27–5.66, p = 0.009), and elevated platelet count at remission (HR 1.004, 95 CI 1.001–1.008, p = 0.021) as independent predictors of early relapse.

Conclusions

Neither induction regime demonstrated longer duration of remission of CD in patients treated with immunomodulators since the time of diagnosis.

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Acknowledgments

The project was supported by the Ministry of Health, Czech Republic, for conceptual development of research organizations 00064203 (University Hospital Motol, Prague, Czech Republic) and project GA UK No. 136215 by the Charles University in Prague.

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Authors and Affiliations

  1. Department of Pediatrics, University Hospital Motol and Second Faculty of Medicine, Charles University in Prague, V Uvalu 84, 150 06, Prague 5, Czech Republic

    Ondrej Hradsky, Ivana Copova, Kristyna Zarubova, Jiri Nevoral & Jiri Bronsky

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  1. Ondrej Hradsky
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  2. Ivana Copova
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Correspondence to Ondrej Hradsky.

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Appendix

Appendix

See Table 4 and Fig. 4.

Table 4 Predictors of the time to first relapse among all included subjects
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Hradsky, O., Copova, I., Zarubova, K. et al. Time to Relapse in Children with Crohn’s Disease Treated with Azathioprine and Nutritional Therapy or Corticosteroids. Dig Dis Sci 61, 2041–2050 (2016). https://doi.org/10.1007/s10620-016-4103-8

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