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Risk Factors of Clinical Relapses in Pediatric Luminal Crohn's Disease: A Retrospective Cohort Study
Samuel Sassine1,2, Lisa Djani1,2, Christine Cambron-Asselin1,2
1CHU Sainte-Justine Research Center, Montreal, Quebec, Canada.
Insights
Pediatric Crohn's disease relapse rates have declined. Female sex, certain medications, granulomas, high inflammatory markers, and low infliximab levels are associated with increased relapse risk in children with Crohn's disease.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Limited understanding of factors influencing Crohn's disease (CD) relapse in pediatric populations.
- Need to identify predictors for improved management of pediatric CD.
Purpose of the Study:
- To identify risk factors for relapse in pediatric Crohn's disease.
- To analyze trends in pediatric CD relapse rates over the last decade.
Main Methods:
- Retrospective cohort study of pediatric CD patients diagnosed between 2009-2019.
- Analysis of clinical, endoscopic, histological, and laboratory data.
- Utilized survival analyses and Cox regression models to determine risk factors.
Main Results:
- A significant decrease in clinical relapse rate observed over the decade (70.9% vs. 49.1%).
- Risk factors for relapse included female sex, oral 5-ASA use, immunomodulatory agents, granulomas, eosinophils, elevated CRP and fecal calprotectin, and low infliximab levels.
- Adjusted hazard ratios (aHR) quantified the impact of these variables.
Conclusions:
- Pediatric Crohn's disease relapse rates have decreased over the past ten years.
- Relapse risk is significantly associated with a combination of clinical, endoscopic, histological, laboratory, and treatment-related factors.
- These findings can inform targeted interventions and personalized treatment strategies for pediatric CD.
Introduction:
There is currently little knowledge on factors associated with the relapse of Crohn's disease (CD) in children. The aims of this study were to describe the risk factors associated with relapse in pediatric CD and the changes in the relapse rate over the past decade.
Methods:
Patients younger than 18 years and diagnosed between 2009 and 2019 were included in this retrospective cohort study. Clinical, endoscopic, histological, and laboratory data, as well as induction and maintenance treatments, were collected from the medical records. Survival analyses and Cox regression models were used to assess the impact of these risk factors on relapse.
Results:
Six hundred thirty-nine patients were included. There was a decrease in the clinical relapse rate over the past decade: 70.9% of the patients diagnosed between 2009 and 2014 relapsed as compared with 49.1% of the patients diagnosed between 2015 and 2019 (P < 0.0001). The following variables were associated with clinical relapse: female sex (adjusted hazard ratio [aHR] = 1.52, P = 0.0007), exposure to oral 5-ASA (aHR = 1.44, P = 0.04), use of immunomodulatory agents compared with tumor necrosis factor-alpha inhibitors (methotrexate aHR = 1.73, P = 0.003; thiopurines aHR = 1.63, P = 0.002), presence of granulomas (aHR = 1.34, P = 0.02) and increased eosinophils on intestinal biopsies (aHR = 1.36, P = 0.02), high levels of C-reactive protein (aHR = 1.01, P < 0.0001) and fecal calprotectin (aHR = 1.08, P < 0.0001), and low serum infliximab levels (aHR = 2.32, P = 0.001).
Discussion:
Relapse of pediatric CD has decreased in the past decade. The risk of relapse is significantly associated with clinical, endoscopic, histological, and laboratory variables and treatment strategies.
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