Treatment strategies, clinical variables predict relapse in paediatric CD

The past decade has seen a decline in clinical relapses of paediatric luminal Crohn’s disease (CD), according to a study. Relapse risk is associated with clinical, endoscopic, histological, and laboratory variables and treatment strategies.

In this retrospective cohort study, the investigators sought to describe the risk factors associated with relapse in paediatric CD and the changes in the relapse rate over the past decade. Patients aged <18 years and diagnosed between 2009 and 2019 were included.

The investigators used medical records to obtain clinical, endoscopic, histological, and laboratory data, as well as induction and maintenance treatments. They also assessed the impact of these factors on relapse risk using survival analyses and Cox regression models.

A total of 639 patients were analysed. A decrease in clinical relapse rate was observed over the past decade. Of the participants, 70.9 percent diagnosed between 2009 and 2014 relapsed as opposed to 49.1 percent of those diagnosed between 2015 and 2019 (p<0.0001).

Clinical relapse was significantly associated with the following variables: 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 vs tumour 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 faecal calprotectin (aHR, 1.08; p<0.0001), and low serum infliximab levels (aHR, 2.32; p=0.001).