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Exclusive enteral nutrition induced remission in pediatric Crohn's disease
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Treatment of active pediatric Crohn’s disease with exclusive enteral nutrition therapy was highly effective and induced remission, but efficacy decreased with repeated courses, according to recent study data.
Researchers conducted a retrospective study of all pediatric Crohn’s disease (CD) patients treated with exclusive enteral nutrition (EEN) at a children’s hospital in Munich between January 2004 and June 2011. Fifty-two included patients (mean age, 13.2 years; 59.6% male) had newly diagnosed CD (n=40) or had relapsed (n=12) while maintaining treatment for at least 3 months. Patients exposed to anti-tumor necrosis factor or corticosteroids 3 months before EEN were excluded.
Twenty-six patients who received a second course of EEN to manage disease exacerbation also were screened to allow researchers to compare outcomes of first and second treatment courses. Remission and relapse were defined by the weighted Pediatric Crohn’s Disease Activity Index (wPCDAI; range, 0-125). Genetic biomarkers related to long-term remission after EEN also were identified and analyzed.
The first course of EEN showed a higher median starting wPCDAI score compared with the second (59 vs. 40; P<.0001), as well as higher remission rates after 3 months (92% vs. 77%). Relapse rates after 1 year were comparable (67% vs. 70%), but fewer relapses occurred in the first 120 days after the first EEN course compared with the second (25% vs. 45%).
Of 48 patients with NOD2 genotype, 44 went into remission with EEN; 11 of 12 patients carrying R702W or G908R genotype relapsed within 1 year; and there were significantly lower rates of relapse in patients with wild-type (60%) or 1007fs (50%) mutations.
While two-thirds of the cohort relapsed during year one of follow-up, and half were retreated with a second course of EEN but with a lower success rate, the researchers wrote that “the immediate benefits of EEN in active CD are evident.”
“Our data support the efficacy of repeated nutritional therapy for active CD, regardless of disease phenotype,” the investigators concluded.
Disclosure: See the study for a full list of relevant financial disclosures.
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