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

Hradský, Ondřej; Copova, Ivana; Zárubová, Kristýna; Nevoral, Jiří; Bronský, Jiří

doi:10.1007/s10620-016-4103-8

Cited by 10 publications

(17 citation statements)

References 44 publications

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“…However, the proportion of patients in clinical remission was similar at week 52 between the two groups [13]. In maintenance remission, there were no differences between patients initially treated with EEN or corticosteroids [17].…”

Section: Introductionmentioning

confidence: 78%

Outcomes of Pediatric Patients with Crohn’s Disease Received Infliximab or Exclusive Enteral Nutrition during Induction Remission

Lou

Yang

et al. 2022

Gastroenterology Research and Practice

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Background. Both exclusive enteral nutrition (EEN) and infliximab (IFX) are recommended as induction therapy for pediatric Crohn’s disease (CD). Our aim was to compare long-term disease outcomes of patients initially received with either IFX or EEN. Methods. Medical records of newly diagnosed, therapy naïve pediatric patients with CD received with IFX or EEN as induction therapy were retrospectively enrolled. Pediatric Crohn’s disease activity index (PCDAI), Crohn’s disease endoscopic index of severity (CDEIS), and other clinical data were compared pre- and postinduction therapy in two groups. The sustained remission rates and time coupled with body mass index (BMI) and height for age (HFA) changes were evaluated during more than 2-year long-term follow-up. Results. We collected data from 58 children with CD used IFX (23) or EEN (35) as induction remission therapy from January 2015 through June 2021 in our single-center. The median follow-up after starting IFX or EEN was 12.2 months (6.5–18.0months) and 18.9 months (7.1–30.7months), respectively. The proportion clinical and endoscopic remission in EEN (88.57% and 68.75%) was similar with that of IFX (73.91% and 80.77%) after induction therapy. No significant differences were also observed in BMI and HFA recovery between two groups. Among those who achieved clinical or endoscopic remission or endoscopic response, the sustained remission rates and time did not reveal any significant differences for those 10 patients who used 6-mercaptopurine/methotrexate (6-MP/MTX) or 14 patients who used IFX as maintenance treatment during longitudinal follow-up. Conclusions. Our study suggested that EEN treatment is similar with IFX therapy in short-term outcomes, and EEN+6-MP/MTX treatment is comparable with IFX+IFX therapy in long-term outcomes.

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Section: Introductionmentioning

confidence: 78%

Outcomes of Pediatric Patients with Crohn’s Disease Received Infliximab or Exclusive Enteral Nutrition during Induction Remission

Lou

Yang

et al. 2022

Gastroenterology Research and Practice

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“…After 4 wk of treatment, the dose was reduced ( n = 23)EEN: 9.3 ± 2.6CS: 10.2 ± 3.1Children with diagnosed CD12CDAI < 150 points or lower than the baseline value of at least 100 points and CRP normal9 Hojsak et al [48]CroatiaEEN: polymeric formula, taken exclusively for 6–8 wk either through nasogastric tube or orally ( n = 57)CS: corticosteroids ( n = 17).13.4 (1–17.9)Children with newly diagnosed CD6–8PCDAI < 108 Grover et al [49]AustraliaEEN: polymeric formula, Nutrison (1 kcal/mL, Nutricia, UK, 4 g protein, 3.9 g fat/100 mL) through nasogastric tube (NGT) or resource protein (1.25 kcal/mL, Nestle, 9.4 g protein, 3.5 g fat/100 mL) orally based on children preference and dietetic consultation ( n = 43)CS: corticosteroids: 10 mg/d prednisolone ( n = 46)EEN: 13 (11.35–14)CS: 11.5 (9.5–13)Children with newly diagnosed CD6PCDAI < 109Luo et al [50]ChinaEEN: polymeric formula, the average caloric intake in EEN group was 117.9 ± 4.2 kcal ( n = 10)CS: the average dosage for prednisone was 1.1 ± 0.4 mg/kg ( n = 15). The average dosage for hydrocortisone was 8.7 ± 2.3 mg/kg ( n = 3)EEN: 11.1 (5–15)CS: 11.6 (1–16)Children with active CD (PCDAI > 10)8PCDAI < 108 Hradsky et al [51]Czech RepublicEEN: polymeric formula ( n = 29)CS: prednisone 1–2 mg/kg/d (up to 40 mg/d, exceptionally 60 mg/d) approximately 2 mont ( n = 36)EEN: 13.91 (12.3–15.02)CS: 14.85 (11.25–15.57)Children with newly diagnosed CD6–10NG7 Goncalves et al [52] (abstract)PortugueseEEN: polymeric formula for 8 wk (1500–2000 mL/d) ( n = 11)CS: the steroid dose was 1 mg/kg/d ( n = 19)There was no difference in ageChildren with newly diagnosed CD8NG7 Gavin et al [53] (abstract)UKEEN: exclusive enteral nutrition ( n = 43)CS: st...…”

Section: Resultsmentioning

confidence: 99%

Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn’s disease: a meta-analysis

Chen

2019

World J Pediatr

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Background Many studies have examined the effects of exclusive enteral nutrition (EEN) in children with Crohn’s disease (CD), but corticosteroids are considered a superior therapy and are frequently used in China. This meta-analysis aims to compare the efficacy of EEN with corticosteroids in treating pediatric CD. Methods A comprehensive retrieval from medical databases, including PubMed, EMBASE, MEDLINE, Web of Science, Wanfang data, VIP and CNKI, was performed using the search terms “diet therapy”, “exclusive enteral nutrition”, “Crohn’s disease”, “inflammatory bowel diseases”, “child” and “pediatrics” from January 1990 to April 2017. Results We included 18 studies from 1329 identified sources in this meta-analysis. EEN was as effective as corticosteroids in inducing remission rate of children suffering from CD (OR = 1.35; 95% CI 0.90, 2.10; P = 0.14). Nevertheless, patients who received EEN were more likely to achieve both endoscopic mucosal healing (OR = 5.24; 95% CI 2.06, 13.37; P = 0.0005) and histological mucosal healing (OR = 4.78; 95% CI 1.89, 12.08; P = 0.0009) than those who received corticosteroids; the Pediatric Crohn’s Disease Activity Index was lower [mean difference (MD) = − 3.67; 95% CI − 4.91, − 2.43] and weight gain was higher (MD = 1.92; 95% CI 0.02, 3.83; P = 0.05) in those patients who received EEN than in those who received corticosteroids. No difference was found in relapse rate (OR = 0.57; 95% CI 0.25, 1.29; P = 0.18), height for age or body mass index between the patients treated with EEN and corticosteroids at the 1-year end point. Conclusions This meta-analysis reveals that there is no significant difference between EEN and corticosteroids in the efficacy of inducing remission rate of CD in a pediatric population, but EEN is superior to corticosteroids in improving short-term mucosal inflammation and reducing the PCDAI index. Electronic supplementary material The online version of this article (10.1007/s12519-018-0204-0) contains supplementary material, which is available to authorized users.

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“… 12 , 14 , 16 , 18 , 20 , 26 , 30 , 31 , 34 , 35 , 36 , 38 , 40 , 42 , 44 , 46 , 47 , 51 , 54 – 56 In addition, most studies also addressed the most important confounding factors. 14 , 16 , 17 , 22 , 26 , 28 – 30 , 33 , 38 , 39 , 41 , 48 , 49 , 51 , 52 , 56 , 57 The results of a few studies did not fit well with other available evidence. 14 , 17 , 18 , 19 , 28 , 30 , 32 , 38 , 40 , 41 , 52 ,…”

Section: Resultsmentioning

confidence: 81%

“…Thirty-six studies 12,13,14,15,16,[18][19][20][21][22][23][24][25][26][28][29][30][31][32]34,[37][38][39][40][41][42][44][45][46][47]48,49,[51][52][53]55 considered patients only affected by CD, while 10 also included patients with UC. 17,27,33,35,36,43,50,54,56,57 Three studies evaluated only paediatric IBD patients 20,39,53 whereas 20 studies assessed adult patients exclusively. 12,16,…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…The number of patients included in each study and the observation period varied widely, ranging from 51 23 to 10,367 17 and from 30 days 21,54 to 16 years, 44 respectively. Forty-nine composite outcomes were registered from a total of 43 studies 12,13,14,15,16,[17][18][19][20][21][22][23][24][25][26][27]29,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]54,[55][56][57] and four aggregate outcomes from four studies. 20,28,…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Composite outcomes in observational studies of Crohn’s disease: a systematic review and meta-analysis

Magro

Sottomayor

Alves

et al. 2022

Therap Adv Gastroenterol

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Background: This systematic review and meta-analysis aims to assess composite and aggregate outcomes of observational studies in Crohn’s disease and to evaluate whether the number and type of variables included affect the frequency of the outcome. Methods: MEDLINE [via PubMed], Scopus and Web of Science were searched to identify observational studies that enrolled patients with Crohn’s disease and evaluated a composite or aggregate outcome. The proportion of patients achieving the outcome was determined and a random-effects meta-analysis was performed to evaluate how the frequency of each outcome varies according to the reporting of predefined variables. Results: From 10,257 identified records, 46 were included in the qualitative analysis and 38 in the meta-analysis. The frequency for composite and aggregate outcomes was 0.445 [95% confidence interval (CI): 0.389–0.501] and 0.140 (95% CI: 0.000–0.211), respectively. When comparing composite outcomes by number of included variables, the frequency was 0.271 (95% CI: 0.000–0.405) and 0.698 (95% CI: 0.651–0.746), for one and six variables, respectively. The frequency of the composite outcome varied according to the identity of the variables being reported. Specific pairs of predefined variables had a significant effect in the frequency of composite outcomes. Conclusion: Composite outcomes with increasing number of predefined variables show an increase in frequency. Outcomes including variables such as ‘Surgery’ and ‘Steroids’ had higher frequencies when compared with the ones that did not include these variables. These results show that the frequency of composite outcomes is dependent on the number and type of variables being reported.

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

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

Cited by 10 publications

References 44 publications

Outcomes of Pediatric Patients with Crohn’s Disease Received Infliximab or Exclusive Enteral Nutrition during Induction Remission

Outcomes of Pediatric Patients with Crohn’s Disease Received Infliximab or Exclusive Enteral Nutrition during Induction Remission

Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn’s disease: a meta-analysis

Composite outcomes in observational studies of Crohn’s disease: a systematic review and meta-analysis

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