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According to new study results presented at Digestive Disease Week (DDW) 2009, a high proportion of children with moderate to severe Crohn's disease treated with corticosteroids become corticosteroid dependent, particularly girls and children diagnosed at an earlier age.
Alfreda Krupoves, MD, MSc, Saint Justine University Hospital Centre (CHU Sainte-Justine), Montreal, Quebec, and colleagues reported on the results of a study conducted to assess the short- and long-term outcomes of the first course of corticosteroid therapy in children with Crohn's disease to examine potential factors that may predict corticosteroid responsiveness.
Based on the findings, the authors concluded that alternatives to corticosteroids are needed, particularly in girls and children diagnosed with Crohn's disease at a younger age.
The study included 195 children diagnosed with Crohn's disease who received corticosteroids within 1 year of diagnosis. Diagnosis was based on standard criteria used at a pediatric gastroenterology clinic in Montreal, and clinical phenotypes were classified using the Montreal Classification.
Of the 195 children, 113 (57.95%) were male; mean age at diagnosis was 11.62 years for males and 13.11 years for females. Disease location was in the ileum and upper digestive tract in 27 children (13.85%), colon and upper digestive tract in 53 children (27.18%), and ileocolon and upper digestive tract in 115 children (58.97%). In all, 174 children (89.23%) had inflammatory disease and 21 children (10.77%) had penetrating and stricturing disease.
Immediate response to treatment was assessed on day 30 of corticosteroid therapy. Of the 195 children, 109 (55.9%) achieved a complete response, 73 (37.44%) achieved a partial response, and 13 (6.66%) did not respond. Of the 182 responders (93.34%), 72 (39.56%) became corticosteroid dependent and 110 (61.44%) had a prolonged response.
As shown by logistic regression analyses, children who became corticosteroid dependent were more likely to be diagnosed with Crohn's disease at a younger age compared with children who had a prolonged response (odds ratio [OR] = 0.85; 95% confidence interval [CI], 0.77 to 0.94; P = .002), and girls were more likely not to respond to corticosteroids compared with boys (OR = 3.36; 95% CI, 0.99 to 11.31; P = .051).
No association was found between corticosteroid response and clinical phenotype.
Digestive Disease Week 2009 is cosponsored by the American Association for the Study of Liver Disease (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society for Surgery of the Alimentary Tract (SSAT).
Research Title: Immediate and Long-Term Response to Corticosteroid Therapy in Pediatric Crohn's Disease Patients. Abstract M1160