Combining thiopurine with partial enteral nutrition promotes complete mucosal healing in pediatric Crohn's disease
Emiri Kaji1, Atsushi Yoden1,2, Takahiro Namba1
1Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.
Insights
Thiopurines and partial enteral nutrition (TP/PEN) significantly improved mucosal healing in pediatric Crohn's disease patients. While relapse rates were similar, TP/PEN offers a viable treatment option for achieving remission.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Nutrition
Background:
- Partial enteral nutrition (PEN) combined with thiopurines (TP) is a standard maintenance therapy for mild-to-moderate pediatric Crohn's disease (CD).
- Limited evidence exists on the efficacy of TP/PEN for pediatric CD.
- This study evaluates TP/PEN versus PEN alone in pediatric CD patients.
Purpose of the Study:
- To assess the non-relapse rate in pediatric CD patients treated with TP/PEN versus PEN-only.
- To evaluate the complete mucosal healing rate in pediatric CD patients receiving TP/PEN versus PEN-only.
- To determine the long-term efficacy of TP/PEN in managing pediatric Crohn's disease.
Main Methods:
- Retrospective observational study of 39 pediatric CD patients.
- Patients categorized into TP/PEN and PEN-only groups.
- Primary outcome: relapse-free rate (defined by PCDAI, SES-CD, Lewis score, CRP). Secondary outcome: complete mucosal healing (SES-CD score 0) at 12-24 months.
Main Results:
- No statistically significant difference in non-relapse rates between TP/PEN and PEN-only groups.
- Significantly higher complete mucosal healing rates in the TP/PEN group (33.3%) compared to the PEN-only group (5.5%) at 12-24 months (p < 0.05).
- TP/PEN demonstrated superior efficacy in achieving mucosal healing.
Conclusions:
- TP/PEN is a viable treatment option for pediatric patients with mild-to-moderate Crohn's disease.
- The combination therapy shows promise in achieving complete mucosal healing.
- Further research may explore optimal therapeutic strategies in pediatric CD management.
Background:
The combination of thiopurines and partial enteral nutrition (TP/PEN) is a common maintenance therapy for mild-to-moderate Crohn's disease (CD) in pediatric patients. However, no studies have investigated the efficacy of TP/PEN. This study aimed to evaluate the non-relapse and complete mucosal healing rates in pediatric CD patients following treatment with or without TP, in addition to PEN.
Methods:
This retrospective observational study included 39 pediatric patients diagnosed with mild-to-moderate CD. Based on the proposed treatment, the patients were divided into the TP/PEN and PEN-only groups. The primary outcome was the relapse-free rate between the two groups. Relapse was defined as a pediatric Crohn's disease activity index (PCDAI) >12.5, Simple Endoscopic Score-CD (SES-CD) score >7, Lewis score > 135, and/or abnormal C-reactive protein levels (CRP > 0.15 mg/dL). The secondary outcome was complete mucosal healing (SES-CD score 0) at 12-24 months.
Results:
Although the difference in non-relapse rate between the two groups was not statistically significant, complete mucosal healing rates were significantly higher in the TP/PEN group than in the PEN-only group. Complete mucosal healing at 12-24 months was achieved in 7/21 (33.3%) and 1/18 (5.5%) patients in the TP/PEN and PEN-only groups, respectively (p < 0.05).
Conclusion:
Nowadays, more treatment options are available, and TP/PEN remains a viable option for the treatment of mild-to-moderate CD in pediatric patients.
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