P624 Maintenance of remission after treatment with Exclusive Enteral Nutrition and Azathioprine in paediatric patients with Crohn’s disease
G. Pujol Muncunill, A.I. Pascual-Pérez, P. Dominguez-Sánchez, S. Feo-Ortega, M. Suárez-Galvis, V. Vila-Miravet, F.J. Martin de Carpi
Hospital Sant Joan de Déu, Unit for the Comprehensive Care of Pediatric Inflammatory Bowel Disease. Department of Pediatric Gastroenterology- Hepatology and Nutrition, Esplugues de Llobregat, Spain
Background
Several studies have shown the efficacy of Exclusive Enteral Nutrition (EEN) in patients with Crohn’s disease (CD) for the induction of remission. ECCO-ESPGHAN guidelines recommend the use of EEN combined with early use of immunosuppressants in paediatric patients with mild-to-moderate CD. However, there is a lack of data to show its efficacy in the long term to avoid or postpone the use of biological treatment. The aim of our study is to know how many of our patients that have achieved remission with EEN and Azathioprine (AZA), required to step up to biological treatment during the follow-up.
Methods
Retrospective analysis of paediatric patients with Crohn’s disease that were diagnosed at our Unit between 2003 and 2017. We included those patients that achieved clinical remission after treatment with EEN and AZA. We analyse demographics, clinical and follow-up data until February 2019 or until they are transferred to an adult inflammatory bowel disease (IBD) unit.
Results
We included 91 patients that achieved clinical remission after treatment with EEN and AZA (68.1% males; Mean age at diagnosis: 12.29 years; Median age at diagnosis: 13 years (range 8 months-17 years). The mean time of follow-up was 60.45 months (range: 8–165 months). During this period, 66/91 patients (72.5%), had a flare. Seventeen of those patients (20.2%) received a second cycle of EEN, being effective in 7 (41.2%). Mean time from diagnosis until the second cycle of EEN was 13.76 months (maximum: 110 months). Globally, 64.8% of our patients required to step up to biological therapy with a mean time from onset to biologics of 15.3 months (median 9 months). Seventy-two per cent of those who needed biological treatment started Adalimumab (ADA). During the follow-up, 42.2% of the patients with combo therapy could withdraw AZA, being the main reason (76.3%) clinical and endoscopic remission.
Conclusion
Even though EEN is an effective treatment for the induction of the remission in paediatric CD, in the long term we are not able to maintain that remission and an important percentage of patients require to step up to biological therapy. The definition of more strict criteria of remission is necessary in order to establish the most suitable maintenance treatment for each patient.