Immediate and long-term outcomes of corticosteroid therapy in pediatric Crohn's disease patients

Alfreda Krupoves, David R. Mack, Ernest G. Seidman, Colette Deslandres, Vytautas Bucionis, Devendra K. Amre

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Although a mainstay of treatment of moderate to severe Crohn's disease (CD), corticosteroids use presents significant challenges because of large interindividual variability in response. Corticosteroid-dependence is of particular concern in children, where high rates have been reported. We examined the burden of corticosteroid-resistance and dependence in a well-characterized cohort of pediatric CD patients and investigated potential predictors of response. Methods: Children diagnosed with CD (<18 years), were recruited from two Canadian pediatric gastroenterology clinics. Immediate and long-term responses to corticosteroid therapy were retrospectively ascertained. Response rates (resistance and dependence) were estimated and potential predictors assessed using logistic regression analysis. Results: Of the 645 CD patients, 364 (56.2%) received corticosteroids. The frequency of corticosteroid-resistance was (8.0%) (95% confidence interval [CI]: 5.0%-11%) and 40.9% (95% CI: 39.0%-46.0%) became dependent. In univariate analysis female gender (odds ratio [OR] = 2.49, 95% CI: 1.1-5.5, P = 0.025), disease severity (OR = 2.43, 95% CI: 1.10-5.38, P = 0.029), and complicated disease (OR = 2.75, 95% CI: 1.18-6.41, P = 0.019) were associated with resistance. In multivariate analysis lower age at diagnosis (OR = 1.34,95% CI: 1.03-3.01, P = 0.040), coexisting upper digestive tract involvement (OR = 1.35, 95% CI: 1.06-3.07, P = 0.031), and concomitant immunomodulator use (OR = 0.35, 95% CI: 0.16-0.75, P = 0.007) were significantly associated with steroid dependency. Conclusions: Our results demonstrate that steroid dependency is a frequent complication in children with CD. Children with an earlier age at diagnosis and coexisting upper digestive tract involvement could be potentially targeted for steroid-sparing therapy.

Original languageEnglish (US)
Pages (from-to)954-962
Number of pages9
JournalInflammatory bowel diseases
Volume17
Issue number4
DOIs
StatePublished - Apr 1 2011

Keywords

  • Corticosteroid-dependence
  • Corticosteroids
  • Crohn's disease
  • Outcomes
  • Pediatrics
  • Predictors

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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