P511 Efficacy of Crohn's Disease exclusion diet in different clinical scenarios in paediatrics; at onset of the disease and after loss of response to biological therapy
Jijón, M.C.(1);Pujol-Muncunill, G.(1);Lozano Ruf, A.(1);Vila Miravet, V.(1);Alvarez Carnero, L.(1);García Arenas, D.(1);Egea Castillo, N.(1);Martín de Carpi, J.(1);
(1)Hospital Sant Joan de Deu, Paediatric Gastroenterology- Hepatology- and Nutrition, Barcelona, Spain;
Background
Crohn's disease (CD) exclusion diet (CDED) associated with partial enteral nutrition (PEN) has showed to induce remission in different clinical scenarios of the disease. Our aim is to evaluate its efficacy at onset and after loss of response to biological treatment in paediatric CD.
Methods
Retrospective observational cohort study of children with CD treated with CDED+PEN. Demographic (gender, age at diagnosis and at CDED initiation), clinical (Paediatric Crohn’s Disease Activity Index (PCDAI) and weight Z score), and analytical (faecal calprotectin (FC), haemoglobin, albumin, C reactive protein (CRP), iron, ferritin, and erythrocyte sedimentation rate (ESR)) variables were analysed at 0, 6, 12, and 24 weeks of treatment. Primary outcome was clinical remission, defined as PCDAI <10 points.
Results
Fifteen patients were included (8 male); group A (n 9; mean age 15.8 years, [IQR:12.6-18.1]) received CDED+PEN at onset, while group B (n 6; mean age 12 years [IQR:10.7-15]) received it after loss of response to biologics. All patients in group A and 2 in B received azathioprine. In group B, 3 patients were on Adalimumab and 3 on Ustekinumab. Adherence at week 6 was 100% in both groups. Group A had a mean PCDAI of 15 [IQR: 11.25-17.5] at baseline and 100% of the patients achieved clinical remission by week 6 and maintained it through week 12; 87% (7/8) maintained clinical remission by week 24. One patient required step-up to Adalimumab due to sustained FC elevation. In group A PCDAI significantly improved at week 6 (p0.09), 12 (p0.002) and 24 (p0.006). FC and albumin also improved at week 6 (p0.02; p0.03), 12 (p0.016; p0.03) and 24 (p0.019; p0.016). ESR improved at weeks 12 (p0.021) and 24 (p0.027). Haemoglobin and iron only improved at week 24 (p0.048; p0.003). The weight Z score, CRP, and ferritin did not improve significantly in group A. In group B mean PCDAI at baseline was 20 [IQR: 3.75-39.38]; 100% achieved clinical remission at week 6 and maintained it at week 12. By week 24, 60% (3/5) maintained clinical remission (1 patient required steroids due to a relapse (moderate activity assessed by colonoscopy) and 1 patient presented with clinical relapse. PCDAI and FC decreased over time but did not reach statistical significance. The rest of variables did not show significant improvement in group B.
Conclusion
Treatment with CDED+PEN was well tolerated and patients had excellent adherence. Our cohort showed better results at disease onset than after loss of response to biologics. However, CDED+PEN is a new promising rescue strategy to treat CD after failure to previous biologics in a safe manner, and without needing to change the therapeutic target.