EEN vs. steroids in pediatric CD

July 30, 2024

Issue 15

Clinical Question

How do long-term outcomes compare between exclusive enteral nutrition and corticosteroids for children with Crohn’s disease?

Editor’s Bottom Line

Although residual confounding can never be eliminated from observational datasets, these results provide a compelling argument for use of exclusive enteral nutrition to treat pediatric Crohn’s disease. More controlled trials in children and adults are needed.

Reference

Plotkin L, Buchuk R, Lujan R, et al. Enteral nutrition compared with corticosteroids in children with Crohn’s disease: A long-term nationwide study from the epi-IIRN. Aliment Pharmacol Ther. 2024;60:224–32. https://onlinelibrary.wiley.com/doi/10.1111/apt.18028

Synopsis

To compare the long-term outcomes of children with Crohn’s disease (CD) receiving exclusive enteral nutrition (EEN) or corticosteroids as induction therapy, researchers used the epi-IIRN cohort which includes all patients diagnosed with IBD in Israel since 2005. The study analyzed data from 410 children treated with EEN and 375 treated with corticosteroids who received induction therapy for at least 30 days. Patients were individually matched using propensity score adjustments.

The study included a median follow-up period of 4.7 years, providing 1433 patient-years of follow-up. Baseline demographics were similar between groups in terms of gender (61% male for EEN, 53% male for corticosteroids), age at diagnosis (13.3 and 13.1, respectively), and time to treatment (0.47 and 0.55 months, respectively). The most used additional medications were 5-Aminosalicylate (ASA) oral (42%, 43%) thiopurines (48%, 49%), methotrexate (32%, 30%), and anti-tumour necrosis factor (TNF) (32%, 30%) for the EEN and corticosteroid groups, respectively.

The probability of a complicated course was significantly higher with corticosteroids than EEN at all time points (14% vs. 4% at 0.5 years, 42% vs. 27% at 3 years, and 54% vs. 41% at 5 years). The probability of steroid-dependency was significantly higher with the corticosteroid group across timepoints (10% vs. 2%, 15% vs. 3%, and 20% vs. 5%, at 0.5, 3 and 5 years, respectively), as was the probability of hospitalizations (20% vs. 11%, 37% vs. 26%, and 55% vs. 38%, at 0.5, 3 and 5 years, respectively).

The choice of the first induction treatment was associated with further utilization of the same intervention.

Induction with EEN was similar to corticosteroids with respect to the probability of surgeries, biologic use, and growth.

Details

Study Design: Population-based cohort
Funding: Leona M. and Harry B. Helmsley Charitable Trust.
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b