Effect of early immunomodulator use in moderate to severe pediatric Crohn disease

Jaya Punati, James Markowitz, Trudy Lerer, Jeffrey Hyams, Subra Kugathasan, Anne Griffiths, Anthony Otley, Joel Rosh, Marian Pfefferkorn, David Mack, Jonathan Evans, Athos Bousvaros, M. Susan Moyer, Robert Wyllie, Maria Oliva-Hemker, Adam Mezoff, Neal Leleiko, David Keljo, Wallace Crandall

Research output: Contribution to journalArticle

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Abstract

Background: The immunomodulators (IMs) 6-mercaptopurine and azathioprine decrease corticosteroid dependence and maintain remission in Crohn's disease (CD). We describe IM use in newly diagnosed pediatric CD, comparing outcomes of "early" versus "late" initiation of therapy. Methods: Data were obtained from pediatric CD patients enrolled in a prospective, multicenter observational study. Moderate/severe disease patients treated with IM were compared for outcomes of remission, corticosteroid use, infliximab therapy, hospitalizations, and CD-related surgery based on timing of initiation of IM therapy. Results: In all, 247 children met the criteria (60% male, mean age 11.9 years); 199 were treated with IM within 1 year of diagnosis; 150 between 0-3 months (early), 49 between 3-12 months (late). Both groups showed a decrease in corticosteroid use by 12 months, at which time proportionately fewer early group patients had received corticosteroids in the preceding quarter (22%) than late groups patients (41%)(P = 0.013). The number of hospitalizations per patient was also noted to be significantly lower in the early group over the 2-year follow-up (P = 0.03). No difference was noted in the rates of remission, infliximab use over time, or surgery. Conclusions: 80% of children with newly diagnosed moderate to severe CD are treated with IM within 1 year. Early IM use is associated with reduced corticosteroid exposure and possibly fewer hospitalizations per patient.

Original languageEnglish (US)
Pages (from-to)949-954
Number of pages6
JournalInflammatory bowel diseases
Volume14
Issue number7
DOIs
StatePublished - Jul 1 2008
Externally publishedYes

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Immunologic Factors
Adrenal Cortex Hormones
Crohn Disease
Hospitalization
6-Mercaptopurine
Azathioprine
Pediatric Crohn's disease
Multicenter Studies
Observational Studies
Therapeutics

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Gastroenterology

Cite this

Punati, J., Markowitz, J., Lerer, T., Hyams, J., Kugathasan, S., Griffiths, A., ... Crandall, W. (2008). Effect of early immunomodulator use in moderate to severe pediatric Crohn disease. Inflammatory bowel diseases, 14(7), 949-954. https://doi.org/10.1002/ibd.20412
Punati, Jaya ; Markowitz, James ; Lerer, Trudy ; Hyams, Jeffrey ; Kugathasan, Subra ; Griffiths, Anne ; Otley, Anthony ; Rosh, Joel ; Pfefferkorn, Marian ; Mack, David ; Evans, Jonathan ; Bousvaros, Athos ; Susan Moyer, M. ; Wyllie, Robert ; Oliva-Hemker, Maria ; Mezoff, Adam ; Leleiko, Neal ; Keljo, David ; Crandall, Wallace. / Effect of early immunomodulator use in moderate to severe pediatric Crohn disease. In: Inflammatory bowel diseases. 2008 ; Vol. 14, No. 7. pp. 949-954.
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abstract = "Background: The immunomodulators (IMs) 6-mercaptopurine and azathioprine decrease corticosteroid dependence and maintain remission in Crohn's disease (CD). We describe IM use in newly diagnosed pediatric CD, comparing outcomes of {"}early{"} versus {"}late{"} initiation of therapy. Methods: Data were obtained from pediatric CD patients enrolled in a prospective, multicenter observational study. Moderate/severe disease patients treated with IM were compared for outcomes of remission, corticosteroid use, infliximab therapy, hospitalizations, and CD-related surgery based on timing of initiation of IM therapy. Results: In all, 247 children met the criteria (60{\%} male, mean age 11.9 years); 199 were treated with IM within 1 year of diagnosis; 150 between 0-3 months (early), 49 between 3-12 months (late). Both groups showed a decrease in corticosteroid use by 12 months, at which time proportionately fewer early group patients had received corticosteroids in the preceding quarter (22{\%}) than late groups patients (41{\%})(P = 0.013). The number of hospitalizations per patient was also noted to be significantly lower in the early group over the 2-year follow-up (P = 0.03). No difference was noted in the rates of remission, infliximab use over time, or surgery. Conclusions: 80{\%} of children with newly diagnosed moderate to severe CD are treated with IM within 1 year. Early IM use is associated with reduced corticosteroid exposure and possibly fewer hospitalizations per patient.",
author = "Jaya Punati and James Markowitz and Trudy Lerer and Jeffrey Hyams and Subra Kugathasan and Anne Griffiths and Anthony Otley and Joel Rosh and Marian Pfefferkorn and David Mack and Jonathan Evans and Athos Bousvaros and {Susan Moyer}, M. and Robert Wyllie and Maria Oliva-Hemker and Adam Mezoff and Neal Leleiko and David Keljo and Wallace Crandall",
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Punati, J, Markowitz, J, Lerer, T, Hyams, J, Kugathasan, S, Griffiths, A, Otley, A, Rosh, J, Pfefferkorn, M, Mack, D, Evans, J, Bousvaros, A, Susan Moyer, M, Wyllie, R, Oliva-Hemker, M, Mezoff, A, Leleiko, N, Keljo, D & Crandall, W 2008, 'Effect of early immunomodulator use in moderate to severe pediatric Crohn disease', Inflammatory bowel diseases, vol. 14, no. 7, pp. 949-954. https://doi.org/10.1002/ibd.20412

Effect of early immunomodulator use in moderate to severe pediatric Crohn disease. / Punati, Jaya; Markowitz, James; Lerer, Trudy; Hyams, Jeffrey; Kugathasan, Subra; Griffiths, Anne; Otley, Anthony; Rosh, Joel; Pfefferkorn, Marian; Mack, David; Evans, Jonathan; Bousvaros, Athos; Susan Moyer, M.; Wyllie, Robert; Oliva-Hemker, Maria; Mezoff, Adam; Leleiko, Neal; Keljo, David; Crandall, Wallace.

In: Inflammatory bowel diseases, Vol. 14, No. 7, 01.07.2008, p. 949-954.

Research output: Contribution to journalArticle

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T1 - Effect of early immunomodulator use in moderate to severe pediatric Crohn disease

AU - Punati, Jaya

AU - Markowitz, James

AU - Lerer, Trudy

AU - Hyams, Jeffrey

AU - Kugathasan, Subra

AU - Griffiths, Anne

AU - Otley, Anthony

AU - Rosh, Joel

AU - Pfefferkorn, Marian

AU - Mack, David

AU - Evans, Jonathan

AU - Bousvaros, Athos

AU - Susan Moyer, M.

AU - Wyllie, Robert

AU - Oliva-Hemker, Maria

AU - Mezoff, Adam

AU - Leleiko, Neal

AU - Keljo, David

AU - Crandall, Wallace

PY - 2008/7/1

Y1 - 2008/7/1

N2 - Background: The immunomodulators (IMs) 6-mercaptopurine and azathioprine decrease corticosteroid dependence and maintain remission in Crohn's disease (CD). We describe IM use in newly diagnosed pediatric CD, comparing outcomes of "early" versus "late" initiation of therapy. Methods: Data were obtained from pediatric CD patients enrolled in a prospective, multicenter observational study. Moderate/severe disease patients treated with IM were compared for outcomes of remission, corticosteroid use, infliximab therapy, hospitalizations, and CD-related surgery based on timing of initiation of IM therapy. Results: In all, 247 children met the criteria (60% male, mean age 11.9 years); 199 were treated with IM within 1 year of diagnosis; 150 between 0-3 months (early), 49 between 3-12 months (late). Both groups showed a decrease in corticosteroid use by 12 months, at which time proportionately fewer early group patients had received corticosteroids in the preceding quarter (22%) than late groups patients (41%)(P = 0.013). The number of hospitalizations per patient was also noted to be significantly lower in the early group over the 2-year follow-up (P = 0.03). No difference was noted in the rates of remission, infliximab use over time, or surgery. Conclusions: 80% of children with newly diagnosed moderate to severe CD are treated with IM within 1 year. Early IM use is associated with reduced corticosteroid exposure and possibly fewer hospitalizations per patient.

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Punati J, Markowitz J, Lerer T, Hyams J, Kugathasan S, Griffiths A et al. Effect of early immunomodulator use in moderate to severe pediatric Crohn disease. Inflammatory bowel diseases. 2008 Jul 1;14(7):949-954. https://doi.org/10.1002/ibd.20412