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P112 Long-term outcome of immunomodulators use in paediatric patients with inflammatory bowel disease

K. van Hoeve*1,2, I. Hoffman1, M. Ferrante2,3, S. Vermeire2,3

1University Hospitals Leuven, Department of Paediatric gastroenterology and Hepatology and Nutrition, Leuven, Belgium, 2Catholic University of Leuven (KU Leuven), TARGID, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Leuven, Belgium, 3University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium

Background

In the era where new powerful biologicals are entering the market, the place of conventional immunomodulators (IMM) in treatment of paediatric inflammatory bowel disease (IBD) is questioned. We studied the long-term outcome of paediatric IBD patients receiving conventional therapy.

Methods

All children with Crohn’s disease (CD) or ulcerative colitis (UC) followed at our centre between July 2008 and July 2018 were retrospectively included. Only children receiving conventional therapy including mesalazine, steroids and IMM (thiopurine, methotrexate) at start were studied. Patients requiring rescue therapy (either biologics or surgery) around diagnosis or with a follow-up (FU) <6 months were excluded. The primary outcome of interest was steroid-free clinical remission without need for rescue therapy at 6 and 12 months after diagnosis and at last FU visit. Cox proportional hazard modelling was performed (Hazard risk: HR (95% CI) to determine variables associated with outcomes.

Results

A total of 221 patients (149 CD and 72 UC; median age at diagnosis 12 [10–14] years) were included (Table 1). We excluded 45 (20%) patients due to insufficient FU (n = 21), need of biologics (n = 22) or surgery around diagnosis (n = 2). The median FU duration was 5 [2–8] years. Steroid-free clinical remission rates decreased from 80% at month 6, and 58% at month 12, to 32% at last FU visit. The likelihood of remaining free of rescue therapy was 53% and 72% at 1 year and 27% and 31% at 5 years for CD and UC patients, respectively (Figure 1). For CD patients, higher CRP [HR 1.007 (1.002–1.011), p = 0.002], lower albumin [1.045 (1.008–1.080), p = 0.016] and growth failure [1.206 (1.011–1.362), p = 0.040] at diagnosis were associated with an increased risk of need of rescue therapy. For UC patients, higher PUCAI score at diagnosis [1.037 (1.009–1.065), p = 0.008] was determined as a risk factor for rescue therapy.

Conclusion

These real-life data in paediatric IBD show that only 32% of children remain free of biologic or surgery 5-years after diagnosis. Especially children with a high disease burden at diagnosis as witnessed by higher CRP, lower albumin and growth failure for CD and higher PUCAI score for UC were more likely to fail conventional therapy. This type of risk stratification algorithms will help to determine which patients will benefit from accelerated step-up therapy.

Table 1. Patients’ characteristics.

Figure 1. Kaplan–Meier analysis showing the likelihood of remaining free of rescue therapy in paediatric IBD patients receiving conventional therapy from diagnosis.