Lv Yao, Lou Yue, Yang Gan, Luo Youyou, Lou Jingan, Cheng Qi, Yu Jindan, Fang Youhong, Zhao Hong, Peng Kerong, Chen Jie
Gastroenterology Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Gastroenterol Res Pract. 2022 Sep 2;2022:3813915. doi: 10.1155/2022/3813915. eCollection 2022.
Both exclusive enteral nutrition (EEN) and infliximab (IFX) are recommended as induction therapy for pediatric Crohn's disease (CD). Our aim was to compare long-term disease outcomes of patients initially received with either IFX or EEN.
Medical records of newly diagnosed, therapy naïve pediatric patients with CD received with IFX or EEN as induction therapy were retrospectively enrolled. Pediatric Crohn's disease activity index (PCDAI), Crohn's disease endoscopic index of severity (CDEIS), and other clinical data were compared pre- and postinduction therapy in two groups. The sustained remission rates and time coupled with body mass index (BMI) and height for age (HFA) changes were evaluated during more than 2-year long-term follow-up.
We collected data from 58 children with CD used IFX (23) or EEN (35) as induction remission therapy from January 2015 through June 2021 in our single-center. The median follow-up after starting IFX or EEN was 12.2 months (6.5-18.0months) and 18.9 months (7.1-30.7months), respectively. The proportion clinical and endoscopic remission in EEN (88.57% and 68.75%) was similar with that of IFX (73.91% and 80.77%) after induction therapy. No significant differences were also observed in BMI and HFA recovery between two groups. Among those who achieved clinical or endoscopic remission or endoscopic response, the sustained remission rates and time did not reveal any significant differences for those 10 patients who used 6-mercaptopurine/methotrexate (6-MP/MTX) or 14 patients who used IFX as maintenance treatment during longitudinal follow-up.
Our study suggested that EEN treatment is similar with IFX therapy in short-term outcomes, and EEN+6-MP/MTX treatment is comparable with IFX+IFX therapy in long-term outcomes.
肠内营养（EEN）和英夫利昔单抗（IFX）均被推荐作为儿童克罗恩病（CD）的诱导治疗方法。我们的目的是比较最初接受IFX或EEN治疗的患者的长期疾病结局。
回顾性纳入初诊、未接受过治疗且接受IFX或EEN作为诱导治疗的儿童CD患者的病历。比较两组诱导治疗前后的儿童克罗恩病活动指数（PCDAI）、克罗恩病内镜严重程度指数（CDEIS）及其他临床数据。在超过2年的长期随访中评估持续缓解率、时间以及体重指数（BMI）和年龄别身高（HFA）的变化。
我们收集了2015年1月至2021年6月在我们单中心接受IFX（23例）或EEN（35例）作为诱导缓解治疗的58例CD儿童的数据。开始IFX或EEN治疗后的中位随访时间分别为12.2个月（6.5 - 18.0个月）和18.9个月（7.1 - 30.7个月）。诱导治疗后，EEN组的临床和内镜缓解比例（88.57%和68.75%）与IFX组（73.91%和80.77%）相似。两组之间在BMI和HFA恢复方面也未观察到显著差异。在实现临床或内镜缓解或内镜反应的患者中，对于纵向随访期间使用6 - 巯基嘌呤/甲氨蝶呤（6 - MP/MTX）的10例患者或使用IFX作为维持治疗的14例患者，持续缓解率和时间均未显示出任何显著差异。
我们的研究表明，EEN治疗在短期结局方面与IFX治疗相似，且EEN + 6 - MP/MTX治疗在长期结局方面与IFX + IFX治疗相当。
