Dawson R, Wands D I F, Logan M, Bremner G, Efklides S, Benn L, Henderson P, Grant H, Meredith J, Armstrong K, Wilson D C, Gerasimidis K, Alex G, Russell R K
Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK.
Department of Gastroenterology, Hepatology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Inflamm Bowel Dis. 2022 Dec 1;28(12):1859-1864. doi: 10.1093/ibd/izac039.
Exclusive enteral nutrition (EEN) is the recommended induction treatment of mild to moderate active pediatric Crohn's disease (CD). This study compared outcomes of 2 proprietary polymeric formulas. Treatment effectiveness was examined along with practical aspects of formula delivery and differences in estimated treatment costs.
Data were retrospectively collected from patients with CD who received a generic oral nutritional supplement (Fortisip) across 2 centers (RCH, Melbourne and RHSC, Edinburgh). This was compared with a prospective cohort (RHC, Glasgow) that used a specialized formula (Modulen IBD). The data collected included patient demographics, remission rates, biochemical markers, administration method, and anthropometrics. The estimated treatment cost was performed by comparing price per kcal between each formula.
One hundred seventy-one patients were included (106 Fortisip, 65 Modulen IBD, 70 female; median age 13.3 yrs). No difference was demonstrated in remission rate (Fortisip n = 67 of 106 [63%] vs Modulen IBD n = 41 of 64 [64%], P = .89), nonadherence rate (Fortisip n = 7 of 106 [7%] vs Modulen IBD 3 of 64 [5%], P = .57) or method of administration (NGT Fortisip use n = 16 of 106 [12%] vs Modulen IBD 14 of 65 [22%]; P = .31). There was no difference in reduction of biochemical disease markers between the groups (C-reactive protein , P = .13; erythrocyte sedimentation rate, P = .49; fecal calprotectin, P = .94). However, there was a cost-saving of around £500/patient/course if the generic oral nutritional supplement was used.
The generic oral nutritional supplement and specialized formulas both had similar clinical effectiveness in induction of remission in pediatric CD. However, there is considerable cost-saving when using a generic oral nutritional supplement.
肠内营养（EEN）是轻至中度活动性儿童克罗恩病（CD）的推荐诱导治疗方法。本研究比较了两种专利聚合物配方奶粉的治疗效果。研究了治疗效果以及配方奶粉输送的实际情况和估计治疗成本的差异。
回顾性收集来自两个中心（墨尔本皇家儿童医院和爱丁堡皇家医院）接受通用口服营养补充剂（Fortisip）的CD患者的数据。将其与使用特殊配方奶粉（Modulen IBD）的前瞻性队列（格拉斯哥皇家医院）进行比较。收集的数据包括患者人口统计学、缓解率、生化指标、给药方法和人体测量学数据。通过比较每种配方奶粉每千卡的价格来估计治疗成本。
共纳入171例患者（106例使用Fortisip，65例使用Modulen IBD，70例女性；中位年龄13.3岁）。缓解率（Fortisip组106例中有67例[63%]，Modulen IBD组64例中有41例[64%]，P = 0.89）、不依从率（Fortisip组106例中有7例[7%]，Modulen IBD组64例中有3例[5%]，P = 0.57）或给药方法（Fortisip组106例中有16例[12%]使用鼻胃管，Modulen IBD组65例中有14例[22%]使用鼻胃管；P = 0.31）方面均无差异。两组间生化疾病标志物降低情况无差异（C反应蛋白，P = 0.13；红细胞沉降率，P = 0.49；粪便钙卫蛋白P = 0.94）。然而，如果使用通用口服营养补充剂，每位患者/疗程可节省约500英镑的成本。
通用口服营养补充剂和特殊配方奶粉在诱导儿童CD缓解方面具有相似的临床效果。然而，使用通用口服营养补充剂可节省大量成本。
