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Steroid dependency and pediatric inflammatory bowel disease in the era of immunomodulators--a population-based study

Christian Jakobsen1, Pia Munkholm, Anders Paerregaard

  • 1Department of Pediatrics, Hvidovre University Hospital, Copenhagen, Denmark. Christian.jakobsen@hvh.regionh.dk

Inflammatory Bowel Diseases
|July 12, 2011
PubMed

Insights

Systemic steroid treatment (SST) and immunomodulators (IM) impact pediatric inflammatory bowel disease (IBD) course. IM use correlated with milder ulcerative colitis, but no significant differences were found between steroid-dependent and prolonged response groups.

Area of Science:

  • Pediatric Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Investigating the effects of systemic steroid treatment (SST) and immunomodulators (IM) on pediatric inflammatory bowel disease (IBD) is crucial.
  • Understanding treatment responses in Crohn's disease (CD) and ulcerative colitis (UC) is essential for managing pediatric IBD.

Purpose of the Study:

  • To evaluate the impact of SST and IM on disease progression in children diagnosed with IBD.
  • To compare outcomes between steroid-dependent (SD) and prolonged response (PRO) groups in pediatric IBD patients.

Main Methods:

  • A cohort study included pediatric IBD patients (<15 years) diagnosed between 1998-2006 in eastern Denmark.
  • Patients initiating their first SST within two years of diagnosis were analyzed for treatment response, surgery rates, and disease activity over a median follow-up of 5.1 years.

Main Results:

  • Of 205 IBD patients, 87 CD and 77 UC patients received SST. Response rates (complete, partial, none) and steroid dependency (SD) or prolonged response (PRO) were recorded.
  • One-year cumulative surgery risk was 11.5% for CD and 7.8% for UC. No significant difference in surgery risk or disease course was observed between PRO and SD groups in either CD or UC.
  • Immunomodulator (IM) use was associated with a milder disease course specifically in ulcerative colitis (UC) patients.

Conclusions:

  • No significant difference in surgery rates or disease course was found between steroid-dependent (SD) and prolonged response (PRO) groups in pediatric IBD.
  • Surgery rates in the era of IM were lower than in pre-IM studies, suggesting a beneficial effect of IM on disease course.
  • IM use appears to mitigate disease severity in pediatric ulcerative colitis.
Abstract

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