Predictors of using biologics within one year after EEN therapy in pediatric Crohn's disease

Biologics are commonly used as the second-line medication for maintenance of remission after exclusive enteral nutrition (EEN) induction in pediatric Crohn's disease (CD). However, predictors of using biologics after EEN therapy in CD are yet to be elucidated. This study explores the predictive factors for the application of biologics in children with CD who had finished 8 weeks of EEN induction.

Seventy-five patients were divided into derivation group (n=54) and validation group (n=21). Baseline characteristics were compared between biological group and non-biological group. Univariate and multivariate analyses were performed to correlate 102 laboratory indicators. Finally, binary stepwise logistic regression was used to construct a prediction model.

The predictor identified for biologic use in the prediction model was complement C4 and red blood cell distribution width (RDW). Complement C4 [odds ratio (OR) =1.04, 95% confidence interval (CI): 1.01-1.07] and RDW (OR =1.41, 95% CI: 1.05-1.91) were identified as significant independent predictors (P<0.05). Patients with baseline complement C4 levels >0.415 g/L and RDW >13.5% were more likely to use biologics within 1 year after EEN.

Complement C4 and RDW are predictors of biologic use within 1 year after EEN-induced clinical remission. Elevated complement C4 and RDW are associated with the use of biologics after induction of remission. However, extensive experimental validation is still required to confirm the above findings.