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Prediction of thiopurine failure in pediatric Crohn's disease: pediatric IBD Porto group of ESPGHAN
T. Lerchova, O. Hradsky, M. Kulich, G. Veres, JA. Dias, M. Sładek, S. Kolacek, S. Van Biervliet, J. Melek, DE. Serban, K. Winther, T. de Meij, J. Schwarz, KL. Kolho, JC. Escher, J. Bronsky
Language English Country United States
Document type Journal Article, Research Support, Non-U.S. Gov't
NLK
Free Medical Journals
from 1967 to 1 year ago
ProQuest Central
from 2016-01-01 to 1 year ago
Health & Medicine (ProQuest)
from 2016-01-01 to 1 year ago
Public Health Database (ProQuest)
from 2016-01-01 to 1 year ago
- MeSH
- Azathioprine therapeutic use adverse effects MeSH
- Crohn Disease * complications diagnosis drug therapy MeSH
- Child MeSH
- Immunosuppressive Agents therapeutic use adverse effects MeSH
- Remission Induction MeSH
- Humans MeSH
- Prospective Studies MeSH
- Recurrence MeSH
- Retrospective Studies MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND: Maintaining of remission early in the disease course of Crohn's disease (CD) is essential and has major impact on the future prognosis. This study aimed to identify baseline predictors to develop model allowing stratification of patients who will not benefit from long-term azathioprine (AZA) treatment and will require more intensive therapy. METHODS: This study was designed to develop clinical prediction rule using retrospective data analysis of pediatric CD patients included in prospective inception cohort. Clinical relapse was defined as necessity of re-induction of remission. Sequence of Cox models was fitted to predict risk of relapse. RESULTS: Out of 1190 CD patients from 13 European centers, 441 were included, 50.3% patients did not experience clinical relapse within 2 years of AZA treatment initiation. Median time to relapse was 2.11 (CI 1.59-2.46) years. Of all the tested parameters available at diagnosis, six were significant in multivariate analyses: C-reactive protein (p = 0.038), body mass index Z-score >0.8 SD (p = 0.002), abnormal sigmoid imaging (p = 0.039), abnormal esophageal endoscopy (p = 0.005), ileocolonic localization (p = 0.023), AZA dose in specific age category (p = 0.031). CONCLUSIONS: Although the possibility of predicting relapse on AZA treatment appears limited, we developed predictive model based on six baseline parameters potentially helpful in clinical decision. IMPACT: The possibility of predicting relapse on AZA treatment appears to be possible but limited. We identified six independent predictors available at diagnosis of early AZA/6-MP treatment failure in pediatric CD patients. Using combination of these factors, a model applicable to clinical practice was created. A web-based tool, allowing estimation of individual relapse risk in pediatric CD patients on a particular therapeutic regimen, has been developed.
Amsterdam UMC location VUMC Amsterdam Netherlands
Children's Hospital University of Helsinki Helsinki Finland
Children's Hospital Zagreb Faculty of Medicine Zagreb Croatia
Department of Pediatrics Faculty of Medicine in Pilsen Charles University Prague Czech Republic
Department of Pediatrics University Hospital Charles University Hradec Kralove Czech Republic
Erasmus MC Sophia Children's Hospital Rotterdam Netherlands
Ghent University Hospital Ghent Belgium
Hospital S Joao do Porto Porto Portugal
Hvidovre Hospital Copenhagen Denmark
Pediatric Institute Clinic University of Debrecen Debrecen Hungary
Polish American Children's Hospital Jagiellonian University Cracow Poland
References provided by Crossref.org
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- $a BACKGROUND: Maintaining of remission early in the disease course of Crohn's disease (CD) is essential and has major impact on the future prognosis. This study aimed to identify baseline predictors to develop model allowing stratification of patients who will not benefit from long-term azathioprine (AZA) treatment and will require more intensive therapy. METHODS: This study was designed to develop clinical prediction rule using retrospective data analysis of pediatric CD patients included in prospective inception cohort. Clinical relapse was defined as necessity of re-induction of remission. Sequence of Cox models was fitted to predict risk of relapse. RESULTS: Out of 1190 CD patients from 13 European centers, 441 were included, 50.3% patients did not experience clinical relapse within 2 years of AZA treatment initiation. Median time to relapse was 2.11 (CI 1.59-2.46) years. Of all the tested parameters available at diagnosis, six were significant in multivariate analyses: C-reactive protein (p = 0.038), body mass index Z-score >0.8 SD (p = 0.002), abnormal sigmoid imaging (p = 0.039), abnormal esophageal endoscopy (p = 0.005), ileocolonic localization (p = 0.023), AZA dose in specific age category (p = 0.031). CONCLUSIONS: Although the possibility of predicting relapse on AZA treatment appears limited, we developed predictive model based on six baseline parameters potentially helpful in clinical decision. IMPACT: The possibility of predicting relapse on AZA treatment appears to be possible but limited. We identified six independent predictors available at diagnosis of early AZA/6-MP treatment failure in pediatric CD patients. Using combination of these factors, a model applicable to clinical practice was created. A web-based tool, allowing estimation of individual relapse risk in pediatric CD patients on a particular therapeutic regimen, has been developed.
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