Time to Relapse in Children with Crohn’s Disease Treated with Azathioprine and Nutritional Therapy or Corticosteroids
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.
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.
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.
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.
Neither induction regime demonstrated longer duration of remission of CD in patients treated with immunomodulators since the time of diagnosis.
KeywordsExclusive enteral nutrition Corticosteroids Crohn’s disease Follow-up Immunosuppressive therapy, azathioprine
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.
Compliance with ethical standards
Conflict of interest
- 3.Buchanan E, Gaunt WW, Cardigan T, Garrick V, McGrogan P, Russell RK. The use of exclusive enteral nutrition for induction of remission in children with Crohn’s disease demonstrates that disease phenotype does not influence clinical remission. Aliment Pharmacol Ther. 2009;30:501–507.CrossRefPubMedGoogle Scholar
- 18.Levine A, Turner D, Pfeffer Gik T, et al. Comparison of outcomes parameters for induction of remission in new onset pediatric Crohn’s disease: evaluation of the porto IBD group “growth relapse and outcomes with therapy” (GROWTH CD) study. Inflamm Bowel Dis. 2014;20:278–285.CrossRefPubMedGoogle Scholar
- 24.Levine A, Koletzko S, Turner D, et al. The ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents. J Pediatr Gastroenterol Nutr.Google Scholar
- 43.Zachos M, Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2007;24:CD000542.Google Scholar