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P153 Type of treating physician is associated with long-term disease outcome in the prospective Belgian paediatric Crohn’s disease registry

L. Wauters*1, F. Smets2, E. De Greef3, P. Bontems4, I. Hoffman5, B. Hauser3, P. Alliet6, W. Arts7, H. Peeters8, S. Van Biervliet9, I. Paquot10, E. Van de Vijver11, M. De Vos12, P. Bossuyt13, J.-F. Rahier14, O. Dewit15, T. Moreels15, D. Franchimont16, V. Muls16, F. Fontaine17, E. Louis17, J.-C. Coche18, J. Paul19, F. Baert20, S. Vermeire1, G. Veereman3

1UZ Leuven, Gastroenterology and Hepatology, Leuven, Belgium, 2UCL St Luc, Paediatric Gastroenterology, Brussels, Belgium, 3UZ Brussel, Paediatric Gastroenterology, Brussels, Belgium, 4HUDERF, Paediatric Gastroenterology, Brussels, Belgium, 5UZ Leuven, Paediatric Gastroenterology, Leuven, Belgium, 6Jessa ziekenhuis, Paediatric Gastroenterology, Hasselt, Belgium, 7ZOL Genk, Paediatric Gastroenterology, Genk, Belgium, 8ST Lucas, Gastroenterology, Ghent, Belgium, 9UZ Gent, Paediatric Gastroenterology, Ghent, Belgium, 10CHC Liège, Paediatric Gastroenterology, Liège, Belgium, 11UZ Antwerpen, Paediatric Gastroenterology, Antwerp, Belgium, 12UZ Gent, Gastroenterology, Ghent, Belgium, 13Imelda ziekenhuis, Gastroenterology, Bonheiden, Belgium, 14UCL Mont Godinne, Gastroenterology, Mont Godinne, Belgium, 15UCL St Luc, Gastroenterology, Brussels, Belgium, 16ULB Erasme, Gastroenterology, Brussels, Belgium, 17CHU Liège, Gastroenterology, Liège, Belgium, 18St Pierre, Gastroenterology, Ottignies, Belgium, 19DNA Lytics, Brussels, Belgium, 20Heilig Hart Ziekenhuis, Gastroenterology, Roeselaere, Belgium

Background

Treatment and outcomes in paediatric Crohn’s disease (CD) have not been compared between type of treating physician and centre of care.

Methods

Data from the Belgian paediatric Crohn’s disease registry (BELCRO), an observational prospective cohort of children (< 18 yr) diagnosed with CD in Belgium, were analysed. Disease severity was scored as inactive, mild, and moderate-to-severe, using a 3-point scale and monitored yearly. Response was defined as a decrease of ≥ 1 point from baseline and remission as inactive disease, with sustained response and remission as score 2 and/or 1 for ≥ 2 years follow-up (FU). Univariate analyses were performed between paediatric or adult and secondary or tertiary level of care.

Results

In total, 91 children (median [IQR] age 12.7 [10.9–14.8] yr, 53% male) were included. Disease location was 12% ileal, 23% colonic, 64% ileocolonic, 76% upper GI or 66% proximal (L4A), and 30% perianal. Disease severity at diagnosis was 25% mild and 75% moderate-to-severe. Level of care was 70% paediatric and 71% tertiary. Younger age (11.9 [9.8– 13.4] vs 15.1 [13.8 – 16.7] yr; p < 10–7), and location L4A (77% vs 41%; p = 0.02) were associated with paediatrics. Young age was associated with lower disease severity (11.4 [8.7–13.8] yr for mild and 13.2 [11.6–15.3] yr for moderate-to-severe disease; p = 0.02). Time to biological and combination treatment was longer and duration on biologicals was shorter in paediatrics. Biological (60% vs 26%; p = 0.008) and combination (65% vs 26%: p = 0.005) treatment were initiated more often after first remission by paediatricians. Rates of sustained remission (95% vs 67%; p < 0.001) and response (95% vs 85%; p = 0.04) were higher for paediatric but similar for tertiary care. Time to first or sustained remission and response was shorter and duration of sustained remission was longer in paediatrics.

Table 1 Univariate analyses of treatment and outcome variables between paediatric and adult follow-up

Treatment and outcome variables in years, median (IQR)Follow-up by paediatrician (n = 64)Follow-up by adult physician (n = 27)P-value
Time to biological treatment1.5 (0.7 2.6)0.6 (0.4–1.4)0.003
Time to combination therapy18.5 (8.0–32.5)7.0 (3.0–12.0)0.006
Time on biological treatment3.6 (2.0–4.4)4.6 (2.6–5.0)0.01
Time to first remission0.7 (0.3–1.4)1.2 (0.7–2.5)0.01
Time to first response0.6 (0.3–0.9)0.8 (0.4–1.2)0.02
Time to sustained remission2.6 (2.1–3.2)3.1 (2.5–3.9)0.05
Time to sustained response2.2 (1.9–2.7)2.6 (2.2–3.0)0.003
Duration of sustained remission2.8 (1.6–4.2)2.1 (1.3–3.5)0.004

Mean disease severity during 5 yr FU (1.5 [1.3–1.8] vs 1.8 [1.6–2.0]; p = 0.008) was lower in paediatrics. Rates of inactive disease after 5 yr of FU (73% vs 56%; p = 0.09) were similar with more ongoing immunomodulator treatment (56% vs 33%; p < 0.05) compared with adult care.

Conclusion

Paediatric care was associated with longer delay to and shorter duration on biological or combination treatment with better disease control using a step-up approach. However, long-term outcomes were similar with adult care and use of top-down strategies for more severe disease course in older patients.