Immediate and long-term outcomes of corticosteroid therapy in pediatric crohn's disease patients

✍ Scribed by Alfreda Krupoves; David R. Mack; Ernest G. Seidman; Colette Deslandres; Vytautas Bucionis; Devendra K. Amre

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 200 KB
• Volume: 17
• Category: Article
• ISSN: 1078-0998
• DOI: 10.1002/ibd.21415

✦ Synopsis

Background: Although a mainstay of treatment of moderate to severe Crohn's disease (CD), corticosteroids use presents significant challenges because of large interindividual variability in response. Corticosteroid-dependence is of particular concern in children, where high rates have been reported. We examined the burden of corticosteroid-resistance and dependence in a well-characterized cohort of pediatric CD patients and investigated potential predictors of response.

Methods: Children diagnosed with CD (<18 years), were recruited from two Canadian pediatric gastroenterology clinics. Immediate and long-term responses to corticosteroid therapy were retrospectively ascertained. Response rates (resistance and dependence) were estimated and potential predictors assessed using logistic regression analysis.

Results: Of the 645 CD patients, 364 (56.2%) received corticosteroids. The frequency of corticosteroid-resistance was (8.0%) (95% confidence interval [CI]: 5.0%-11%) and 40.9% (95% CI: 39.0%-46.0%) became dependent. In univariate analysis female gender (odds ratio [OR] ¼ 2.49, 95% CI: 1.1-5.5, P ¼ 0.025), disease severity (OR ¼ 2.43, 95% CI: 1.10-5.38, P ¼ 0.029), and complicated disease (OR ¼ 2.75, 95% CI: 1.18-6.41, P ¼ 0.019) were associated with resistance. In multivariate analysis lower age at diagnosis (OR ¼ 1.34,95% CI: 1.03-3.01, P ¼ 0.040), coexisting upper digestive tract involvement (OR ¼ 1.35, 95% CI: 1.06-3.07, P ¼ 0.031), and concomitant immunomodulator use (OR ¼ 0.35, 95% CI: 0.16-0.75, P ¼ 0.007) were significantly associated with steroid dependency.

Conclusions:

Our results demonstrate that steroid dependency is a frequent complication in children with CD. Children with an earlier age at diagnosis and coexisting upper digestive tract involvement could be potentially targeted for steroid-sparing therapy.