P623 Steroids no more! Exclusive Enteral Nutrition therapy in pediatric patients with Crohn's Disease Results in long-term avoidance of corticosteroid therapy
A. Otley*1, A. Grant2, N. Giffin3, G. Mahdi1, M. Rashid1, J. Van Limbergen1
1IWK Health Centre - Dalhousie University, Pediatric Gastroenterology & Nutrition, Halifax, Canada, 2IWK Health Centre, Gastroenterology, Halifax, Canada, 3Dalhousie University, Undergraduate Medical Education, Halifax, Canada
Exclusive Enteral nutrition (EEN) has been used as a primary therapy for the treatment of pediatric Crohn's Disease (CD). However, it has yet to be widely endorsed as a primary therapy by North American gastroenterologists despite evidence of its efficacy.
Aim: To compare the long-term outcomes of CD patients initially managed with EN versus corticosteroids in a large retrospective cohort.
A single centre, retrospective analysis (1985 to present) of 229 pediatric patients with CD receiving either EEN (n=153) or steroid induction therapy (n=76). EEN was used for a 12 week induction, followed by EN (50% total daily calories) + regular diet as maintenance. Clinical remission was defined as PCDAI ≤ 7.5 without height at baseline and at the 4-8 week follow-up, and ≤ 10 at the 6-, 12-, 24-, and 36-month follow-up visits. A propensity analysis with nearest-neighbour matching, using a 1:2 replacement, and small caliper (.15; allowable standard deviation of estimated propensity score) was carried out. Matched baseline characteristics included gender, age, weight, height, PCDAI and Paris disease locations.
The propensity analysis reduced the sample size of each group, EEN (N=69) and corticosteroid (N = 70), yet reduced bias in initial assignment to therapy. EEN and Steroid patients (33% female in each group) were very similar in age (11.9 ± 3.0, 12.0 ± 2.5 years respectively), Height (146.6 ± 19.6, 147.4 ± 14.5 cm), Weight (36.5 ± 13.7, 37.9 ± 12.3 kg), and disease activity measured by PCDAI (31.1 ± 10.9, 31.8 ± 10.4) at baseline. Initial EEN therapy significantly decreased the risk of exposure to corticosteroids, as 76% and 66% of EEN matched patients remained steroid free over 1 and 3 years, respectively. EEN patients had a quicker induction of remission (4-8 weeks) with 80% of patients achieving clinical remission versus 63% of steroid patients (p < .05). There was a significant growth x group interaction over time, showing that EEN patients height z-score trajectory (-.14 at baseline to .11 at 36 months) was larger than Steroid group patients (p = .02) whose growth remained relatively unchanged from baseline to 36 months (z = -.14 to -.13).
EEN therapy showed more positive effects over time via quicker induction of remission, significant changes in linear growth, and avoidance of corticosteroids over a 3-year follow-up period.