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Treatment response predictive of early relapse in pediatric IBD
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Pediatric patients with inflammatory bowel disease who showed a response at treatment induction were less likely to experience early relapse, according to research published in Alimentary Pharmacology & Therapeutics.
Arie Levine, MD, of the department of pediatric gastroenterology at Wolfson Medical Center in Israel, and colleagues wrote that early treatment response is more predictive of relapse than disease severity at diagnosis, and gaining a better understand of this relationship could lead to personalized disease management strategies for patients.
“Early identification of patients that would benefit from more intensive therapy due to high-risk disease would potentially reduce complications or relapse frequency,” they wrote. “Conversely, patients with lower risk disease may need less potent therapy initially, reducing their therapy risk exposure without compromising prognosis.”
Levine and colleagues analyzed data from the GROWTH CD prospective inception cohort to develop models to help predict relapse after first remission. They enrolled 282 newly diagnosed patients who underwent endoscopies and imaging. Researchers assessed various factors including inflammatory markers and disease activity, which was measured by the Pediatric Crohn’s Disease Activity Index (PCDAI). They followed patients for 78 weeks checking for relapse defined as PCDAI greater than 10 after remission.
After 12 weeks, 178 patients achieved steroid-free remission (63.3%). Researchers identified factors at week 12, including PCDAI less than 5 (P = .02), CRP less than 20 mg/L (P = .02) and fecal calprotectin less than 400 µg/g (P = .03), as cut-offs associated with increased risk for relapse.
Patients who relapsed developed more disease complications compared with patients who did not relapse (29% vs. 9.7%; P = .01).
Additionally, investigators developed a prediction model for patients in remission that assessed factors such as sex, age, week 12 PCDAI, calprotectin and CRP. The model had 43% sensitivity and 93% specificity, as well as 78% positive predictive value and a 71% negative predictive value.
“Relapse risk is influenced more by persistent disease activity and inflammation following induction than baseline severity, inflammation or extent of disease,” Levine and colleagues wrote. “While there remain ‘missing links’ to more comprehensive prediction that warrant further exploration, these findings advance our understanding of relapse risk and more personalized medical choices for children.” – by Alex Young
Disclosures: Levine reports speakers fees, honoraria, advisory boards or licensing fees from AbbVie, Celgene, Janssen and Nestec. Please see the full study for all other authors’ relevant financial disclosures.
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