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DOP Session 3: Epidemiology 1

DOP27 Disease activity patterns in the first 5 years after diagnosis in children with Crohn’s disease: a population-based study.

Distante, M.(1);Rotulo, S.(1)*;Ranalli, M.(1);Pedace, E.(1);Lionetti, P.(2);Arrigo, S.(3);Alvisi, P.(4);Miele, E.(5);Martinelli, M.(5);Zuin, G.(6);Bramuzzo, M.(7);Cananzi, M.(8);Aloi, M.(1);

(1)Umberto I Hospital- Sapienza University of Rome, Department of Maternal and Child Health- Pediatric Gastroenterology and Liver Unit, Rome, Italy;(2)Meyer Children’s Hospital, Unit of Gastroenterology and Nutrition, Florence, Italy;(3)IRCCS- Istituto Giannina Gaslini, Gastroenterologia ed Endoscopia Pediatrica, Genoa, Italy;(4)Maggiore Hospital, Pediatric Gastroenterology Unit, Bologna, Italy;(5)University of Naples “Federico II”, Department of Translational Medical Science- Section of Pediatrics, Naples, Italy;(6)Fondazione MBBM- San Gerardo Hospital, Pediatric Department- University of Milano Bicocca, Monza, Italy;(7)IRCCS “Burlo Garofolo”, Institute for Maternal and Child Health, Trieste, Italy;(8)University Hospital of Padova, Unit of Gastroenterology- Digestive Endoscopy- Hepatology and Care of Children with Liver Transplantation, Padova, Italy; SIGENP IBD Working Group: C. Romano, M.T. Illiceto, S. Salvatore, V. Romagnoli, C. De Giacomo, D.Knafelz, G. Barera, M. Corpino, R. Cozzali, A. Ravelli, G. Castellucci, P. Diaferia, D. Dilillo, M. Baldi, E. Felici, C. Banzato, P.M. Pavanello

Background

This study aimed to define clusters of disease activity and prognostic factors of the disease course in a well-characterized cohort of children with Crohn’s disease (CD).

Methods

All patients with CD identified from the SIGENP IBD registry with a follow-up of at least 5 years and a 6-monthly evaluation were included. Active disease was defined for each yearly semester as follows: clinical activity (wPCDAI≥12,5 or MINI index ≥8), need for treatment escalation, hospitalization, or surgery, active disease on endoscopy (SES-CD >3) or imaging. Formula-based clusters were generated based on previously published patterns in adults 1. Prediction models were created based on clinical, surgical, endoscopic, and laboratory findings at diagnosis and at 6-month follow-up.

Results

Data from 332 patients were analyzed. Ninety-six (29%) had a quiescent course; 52 (16%) and 34 (10%) had a moderate-to-severe chronically active and chronic intermittent disease; 107 (32%) and 43 (13%) had an active disease in the first two years after diagnosis and remission thereafter and the opposite course, respectively. Overall, 129 (39%) children presented with an active disease at 5 years of follow-up, with no patient off-therapy. Surgery at the time of diagnosis was significantly associated with a quiescent course [OR 10.05 (CI 3,05-25,22), p 0.0005], while growth impairment at the diagnosis and moderate-severe activity requiring corticosteroids at 6 months were inversely related to the quiescent group [OR 0.48 (CI 0,27-0,81) p 0.007 and OR 0.35 (CI 0,16-0,71) p 0.005, respectively]. Perianal involvement at diagnosis and moderate-severe activity at 6 months positively correlated with disease progression (i.e., B1 to B2/B3) at follow-up [OR 2.55 (CI 1,05-6,07) p<0.04 and OR 3.85 (CI 1,20-12,85) p 0.02]. Seventy-three patients (22%) required surgery, of which 31 (43%) in the first 6 months after diagnosis.








Conclusion

Approximately one-third of our cohort of children with CD had a quiescent course during the first five years after diagnosis. In contrast, more than one-third of the patients had a chronically or intermittently active disease during the entire follow-up, or an initial remission followed by a persistent activity. Surgery at the time of diagnosis, mild disease onset without growth impairment, and lower disease activity without corticosteroid use in the first six months after diagnosis predicted a quiescent course over time.

1. Wintjens D., Bergey F., Saccenti E. et al. Disease activity patterns of Crohn's disease in the first ten years after diagnosis in the population-based IBD South Limbrug Cohort. J Crohns Colitis. 2021; 15 (3):391-400.