M1161 Extraintestinal Manifestations in Inflammatory Bowel Disease. Are They Associated with More Severe Disease?

Abstract

Background and Objectives: Corticosteroids (CS) are widely used effectively to induce remission in moderate to severe Crohn's disease (CD). However, many patients do not respond (resistant) or require long-term treatment (dependent). CS responsiveness is an important concern in children as it is associated with increased surgical intervention and with susceptibility to side-effects. However, there is limited information on the natural history of CS responsiveness and clinical markers that could enable identification of children likely to respond to CS. We assessed the short and long term outcomes of the first course of CS therapy in children diagnosed with CD and investigated potential predictors of CS responsiveness. Methods: The study cohort comprised of children diagnosed with CD using standard criteria at a paediatric gastroenterology clinic in Montreal, Canada. All patients who received CS within 1 year of diagnosis were included. Clinical phenotypes were classified using the Montreal Classification. The medical files were reviewed retrospectively and sociodemographic and clinical information was abstracted. Recently reported CS response criteria were implemented to assess short and long term outcomes. The immediate response was assessed on 30th day of CS therapy. CS dependency was defined as a clinical relapse occurred during tapering or shortly after CS discontinuation. Chi square and Fisher's exact tests and logistic regression were used to examine the relationship between CS response and variables such as age at diagnosis, gender and clinical phenotypes. Results: A total of 195 patients who were administered CS within 1 year since diagnosis, were identified. The majority of patients were males (113, 57.9%), had ileocolonic CD (L3±L4, 105, 53.8%) and mean age at diagnosis 12.3 (3.6). Of the 195 patients, 13 (6.66%) did not respond to CS, 109 (55.9%) and 73 (37.44%) achieved complete and partial response respectively. Among initial responders 72 (39.56%) became dependent later. Logistic regression analyses revealed that girls were more likely not to respond to CS therapy (OR=3.36; 95% CI, 0.99 to 1.31; p= 0.051). In comparison with patients who had prolonged response, CS dependent patients were more likely to be diagnosed with CD at a younger age (OR =0.85; 95% CI, 0.77 to 0.94, p=0.002). CS response was not associated with CD clinical phenotypes. Conclusion: Our findings highlight that whereas few children with CD are non-responsive to CS, a high proportion become CS dependent.Girls and children diagnosed at an earlier age appear to be more susceptible and alternatives to CS need to be considered in these patients.