P387 Does standard therapy in paediatric Crohn’s disease really prevent our patients from the need of early initiation of anti-TNF treatment?
P. Domínguez Sánchez*, G. Pujol Muncunill, S. Pinillos Pison, V. Vila Miravet, J. Martín de Carpi
Unit for the Comprehensive Care of Paediatric Inflammatory Bowel Disease. Department of Paediatric Gastroenterology, Hepatology and Nutrition. Hospital Sant Joan de Déu, Barcelona, Spain
Previous studies have shown the efficacy of exclusive enteral nutrition (EEN) for induction of remission in paediatric Crohn’s disease (CD). The recent ECCO-ESPGHAN guidelines recommend the use of EEN (6–8 weeks) combined with early use of immunosuppressants as the optimal therapy in these patients at diagnosis. However, a high rate of relapse after EEN has been reported. Moreover, the potential effect of this strategy in postponing or avoiding the future need of biological treatment has not been evaluated. Our aim is to determine the proportion of our CD patients diagnosed in the last years in our Centre and treated with EEN and thiopurines at diagnosis have required escalation to anti-TNF treatment during their follow-up.
Data from our paediatric (age at onset < 18 years of age) CD patients diagnosed in our unit between 2007 and 2014 and who entered remission with EEN combined with thiopurines, were retrospectively collected. The percentage of patients that needed to escalate to anti-TNF therapy (infliximab or adalimumab) after failure of maintenance treatment during their follow-up in our Unit was analysed. The follow-up period was considered until their last visit in our Unit at the time of preparing the abstract (October 2015) or up to the end of the transition programme to an adult IBD Unit.
In total, 50 patients (33 boys; mean age at diagnosis 13.6 years) fulfilled the inclusion criteria. Mean follow-up was 3.2 years; median 2.8 years. During the follow-up in our unit, 38 had a relapse; in 10 of them, a new EEN treatment was initiated, being effective in 5. The other 5 patients and the other 28 received anti-TNF. Up to 66% of the patients required treatment escalation to anti-TNF treatment. Further, 12 patients received infliximab and 21 adalimumab. Mean time to onset of biologics was 465.8 days (median 290 days).
The use of EEN has proved to be effective for the remission of paediatric CD and may delay somewhat the use of biological treatment. However, in our study two-thirds of the patients required escalation of therapy and initiation of anti-TNF treatment. Further studies showing the long-term follow-up of patients treated with standard therapy (EEN and immune-modulators) are needed to know the real effect of this combination in avoiding initiation of biological therapy.