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Article ; Online: Patient, Parent, and Provider Perceptions of Barriers to Pediatric Inflammatory Bowel Disease Care.

Dotson, Jennifer L / Bricker, Josh / Chisolm, Deena J / Mackner, Laura M

JPGN reports

2023 Volume 4, Issue 4, Page(s) e386

Abstract: Objectives: Children with inflammatory bowel disease (IBD) have a significant life-long burden as a result of disease, impacted by environmental and individual barriers. Successful health system interventions require a comprehensive approach, informed ... ...

Abstract	Objectives: Children with inflammatory bowel disease (IBD) have a significant life-long burden as a result of disease, impacted by environmental and individual barriers. Successful health system interventions require a comprehensive approach, informed by various stakeholders. The main objective was to identify health system barriers and potential solutions from existing patients, families, and providers via focus groups. Methods: Participants for the focus groups were existing English-speaking patients (ages 9-18) with IBD, their caregiver(s), and providers including multiple professions (eg, physician, nurse, pediatrician, social worker, care coordinator, scheduler, and psychologist). Separate focus groups were led by experienced personnel for parents, children, and providers, using a standardized interview guide. Sessions were recorded, transcribed, and verified. Using content analysis, we systematically classified data through coding and identified themes. Results: Focus groups comprised (a) 3 patient groups (n = 20, 50% female, including 2 younger; mean age = 11.4 ± 1.5 years) and 1 older group (mean age = 15.6 ± 1.3 years), (b) 3 parent groups (n = 24, 83% female), and (c) 2 multidisciplinary provider groups (n = 19). Families shared several common concerns with providers (eg, school, care delay, psychosocial, and financial) but varied on specifics. Some barriers may be addressable through family or staff education, improved communication (eg, care delay/ access, transition), or training (eg, labs and diet), while others may require change at an institutional or policy level (eg, insurance). Conclusions: This qualitative analysis identified several barriers to IBD care, some shared, some unique to patients, parents, and providers, highlighting the importance of obtaining multiple stakeholder perspectives when exploring barriers to care.
Language	English
Publishing date	2023-11-08
Publishing country	United States
Document type	Journal Article
ISSN	2691-171X
ISSN (online)	2691-171X
DOI	10.1097/PG9.0000000000000386
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Article ; Online: Proactive therapeutic drug monitoring and vedolizumab dose optimization in children with inflammatory bowel disease.

Rowland, Patrick / McNicol, Megan / Kiel, Ashley / Maltz, Ross M / Donegan, Amy / Dotson, Jennifer L / Michel, Hilary K / Boyle, Brendan

Journal of pediatric gastroenterology and nutrition

2024 Volume 78, Issue 4, Page(s) 853–861

Abstract: Objectives: Therapeutic drug monitoring (TDM) and dose optimization have been shown to improve clinical outcomes with antitumor necrosis factor and recent studies in adults suggest an exposure-response relationship with drug levels associated with ... ...

Abstract	Objectives: Therapeutic drug monitoring (TDM) and dose optimization have been shown to improve clinical outcomes with antitumor necrosis factor and recent studies in adults suggest an exposure-response relationship with drug levels associated with improved clinical outcomes. However, these levels are not universally recognized as therapeutic targets for vedolizumab dosing. We aimed to assess the impact of a TDM quality improvement (QI) initiative on 52-week clinical outcomes and describe proactively obtained vedolizumab levels during the induction period in children with inflammatory bowel disease (IBD). Methods: A QI initiative to proactively obtain TDM levels at Week 6 was implemented in 2019. A retrospective review of pediatric patients with IBD treated with vedolizumab from 2018 to 2022 was performed. Baseline demographic data, medication dosing details, disease characteristics, lab results, and 12-month clinical outcomes were recorded. For this study, we defined therapeutic target levels (>20 μg/mL at Week 6 and >12 μg/mL during maintenance) based on existing data correlating these levels with improved clinical outcomes. Results: Fifty-nine patients (31 Crohn disease [CD], 28 ulcerative colitis [UC]/indeterminate colitis [IC]) were included in the study. In total, 68% (40/59) of patients had vedolizumab levels at Week 6 and 90% (53/59) had levels drawn at Week 6 or 14. Thirty-five percent of Week 6 trough levels were below our defined target of 20 μg/mL. Fifty-two of 59 patients had available data at 52 weeks. Over 80% (42/52) of patients remained on vedolizumab 52 weeks after initiation (CD 79% [23/29], UC/IC 83% [19/23]). Sixty-two percent (26/42) of patients that remained on vedolizumab at 52 weeks were treated with an intensified dosing interval of <8 weeks. Thirty-one of these 42 (74%) were in clinical remission (CR) rate at 52 weeks with 29/42 (69%) in corticosteroid-free remission. The CR rate for the entire cohort including those who discontinued therapy due to a lack of efficacy before 52 weeks was 60% (31/52). Conclusion: Proactive TDM and early dose optimization with vedolizumab may improve drug durability and clinical outcomes in pediatric patients with IBD.
MeSH term(s)	Adult ; Humans ; Child ; Drug Monitoring/methods ; Gastrointestinal Agents/therapeutic use ; Inflammatory Bowel Diseases/drug therapy ; Inflammatory Bowel Diseases/pathology ; Antibodies, Monoclonal, Humanized ; Colitis, Ulcerative/drug therapy ; Crohn Disease/drug therapy ; Treatment Outcome
Chemical Substances	vedolizumab (9RV78Q2002) ; Gastrointestinal Agents ; Antibodies, Monoclonal, Humanized
Language	English
Publishing date	2024-01-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1002/jpn3.12132
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Article ; Online: Overweight and Obese Status Is Not Associated With Disease Activity for Children and Adolescents With Newly Diagnosed Inflammatory Bowel Disease.

Jain, Animesh / Bricker, Josh / Kappelman, Michael D / Dotson, Jennifer L

The American journal of gastroenterology

2022 Volume 117, Issue 7, Page(s) 1146–1153

Abstract: Introduction: Despite the high prevalence of pediatric obesity, its impact on Crohn's disease (CD) and ulcerative colitis (UC) activity remains poorly characterized. The aim of this study was to evaluate disease-related outcomes in overweight and obese ... ...

Abstract	Introduction: Despite the high prevalence of pediatric obesity, its impact on Crohn's disease (CD) and ulcerative colitis (UC) activity remains poorly characterized. The aim of this study was to evaluate disease-related outcomes in overweight and obese children with CD and UC. Methods: We conducted a retrospective cohort study using the ImproveCareNow Network, a multicenter registry of children with inflammatory bowel disease. We included children with newly diagnosed CD and UC enrolled in ImproveCareNow Network from September 2006 to December 2018 who had at least 1 follow-up visit 12-18 months after diagnosis. Patients were stratified into normal weight, overweight, or obese categories. Primary outcome was remission at 1 year based on physician's global assessment (PGA); key secondary outcomes included short pediatric CD activity index and pediatric UC activity index. Results: There were 4,972 children included (70% CD). Compared with normal weight, obese and overweight children with CD did not have worse disease activity at 1 year based on PGA. However, obese children did have modestly worse disease activity based on short pediatric CD activity index (inactive 43% vs 58%, mild 48% vs 36%, and moderate-severe 9% vs 7% for obese vs normal weight, P < 0.01). For children with UC, there were no differences in disease activity at 1 year based on PGA or pediatric UC activity index. Logistic regression mirrored these findings. Discussion: Obese and overweight children with newly diagnosed inflammatory bowel disease do not seem to have worsened disease activity at 1 year after diagnosis compared with normal weight children.
MeSH term(s)	Adolescent ; Child ; Chronic Disease ; Colitis, Ulcerative/epidemiology ; Crohn Disease/complications ; Crohn Disease/diagnosis ; Crohn Disease/epidemiology ; Humans ; Inflammatory Bowel Diseases/complications ; Overweight/complications ; Overweight/epidemiology ; Pediatric Obesity/complications ; Prostaglandins A ; Retrospective Studies
Chemical Substances	Prostaglandins A
Language	English
Publishing date	2022-04-26
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	390122-1
ISSN	1572-0241 ; 0002-9270
ISSN (online)	1572-0241
ISSN	0002-9270
DOI	10.14309/ajg.0000000000001803
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Article ; Online: Impact of Telemedicine on Delivery of Pediatric Inflammatory Bowel Disease Care.

Michel, Hilary K / Gorham, Tyler J / Lee, Jennifer A / Liu, Swan Bee / Wright, Molly / Maltz, Ross M / Dotson, Jennifer L

Journal of pediatric gastroenterology and nutrition

2023 Volume 77, Issue 4, Page(s) 519–526

Abstract: Objectives: Outpatient inflammatory bowel disease (IBD) care shifted from office visits (OVs) to a model with integrated telemedicine during the 2020 COVID-19 pandemic. We describe the impact of this shift on delivery of pediatric IBD care.: Methods: ...

Abstract	Objectives: Outpatient inflammatory bowel disease (IBD) care shifted from office visits (OVs) to a model with integrated telemedicine during the 2020 COVID-19 pandemic. We describe the impact of this shift on delivery of pediatric IBD care. Methods: We collected electronic medical record data from office and telemedicine visits for pediatric patients with IBD at a single center from April 2019 to December 2020. We compared visit volume, duration, and test ordering between 2019 and 2020, and between OV and telemedicine, and assessed for differences in telemedicine adoption by sociodemographic factors. Results: Visit volume was maintained between 2019 and 2020. Median overall appointment time was shorter for telemedicine versus OV [46 (interquartile range, IQR 35-72) vs 62 (IQR 51-80) minutes; P < 0.001] with no significant difference in time spent with provider [28 (IQR 21-41) vs OV 30 (IQR 24-39) minutes; P = 0.08]. Accounting for drive time, telemedicine visits were 2.6 times shorter than office visits in 2020 ( P < 0.001). In univariate analyses, there was no difference in telemedicine utilization by race or gender. Variables significantly associated with telemedicine were older age, English as primary language, being non-Hispanic, commercial insurance, living in an area of very high opportunity, and having a longer drive time to the office ( P < 0.05 for all comparisons). In multivariate analyses, visits among patients with commercial insurance were significantly more likely to be conducted via telemedicine ( P = 0.02). Among those with a telemedicine visit, multivariate analyses demonstrated multiracial patients were significantly more likely to have video visits (vs audio-only; P = 0.02), while patients with public insurance, no or missing insurance, and whose primary language was Arabic were significantly less likely to have video visits ( P < 0.05 for all comparisons). Conclusions: Integrated telemedicine allowed for continued delivery of pediatric IBD care and significantly decreased appointment time. While telemedicine may improve access for those who live further from the office, concerns remain about the introduction of disparities.
MeSH term(s)	Humans ; Child ; COVID-19/epidemiology ; Pandemics ; Ambulatory Care ; Inflammatory Bowel Diseases/therapy ; Telemedicine
Language	English
Publishing date	2023-07-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1097/MPG.0000000000003903
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Zs.A 1728: Show issues

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Article ; Online: Successful treatment of cytarabine-related neurotoxicity with corticosteroids, a case series.

Dotson, Jennifer L / Jamil, Muhammad Omer

International journal of hematology

2018 Volume 108, Issue 5, Page(s) 554–557

Abstract: Neurotoxicity from high-dose cytarabine, a pyrimidine metabolite used in treatment for acute myeloid leukemia, is a known but dose-limiting toxicity which has incidences in up to 14% in patients receiving high doses of the drug. Neurologic symptoms vary ... ...

Abstract	Neurotoxicity from high-dose cytarabine, a pyrimidine metabolite used in treatment for acute myeloid leukemia, is a known but dose-limiting toxicity which has incidences in up to 14% in patients receiving high doses of the drug. Neurologic symptoms vary but range from somnolence and ataxia to more severe complications such as seizures and even death. There are no validated treatments other than discontinuation of the drug and supportive measures. We present two cases of cytarabine-related neurotoxicity treated with corticosteroids with complete resolution of symptoms.
MeSH term(s)	Adrenal Cortex Hormones/administration & dosage ; Adult ; Aged ; Cytarabine/administration & dosage ; Cytarabine/adverse effects ; Female ; Humans ; Leukemia, Myeloid, Acute/diagnostic imaging ; Leukemia, Myeloid, Acute/drug therapy ; Neurotoxicity Syndromes/diagnostic imaging ; Neurotoxicity Syndromes/drug therapy ; Neurotoxicity Syndromes/etiology
Chemical Substances	Adrenal Cortex Hormones ; Cytarabine (04079A1RDZ)
Language	English
Publishing date	2018-06-26
Publishing country	Japan
Document type	Case Reports ; Journal Article
ZDB-ID	1076875-0
ISSN	1865-3774 ; 0917-1258 ; 0925-5710
ISSN (online)	1865-3774
ISSN	0917-1258 ; 0925-5710
DOI	10.1007/s12185-018-2485-4
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Article ; Online: Risk of Post-Resection Recurrence in Pediatric Crohn Disease.

Gray, Ashley / Boyle, Brendan / Michel, Hilary K / Wright, Molly / Dotson, Jennifer L / Maltz, Ross M

Journal of pediatric gastroenterology and nutrition

2022 Volume 74, Issue 6, Page(s) 794–800

Abstract: Background: Ileocecectomy related to stricturing, fistula formation, or medically refractory disease is commonly required in patients with Crohn disease (CD). Limited research exists in endoscopic recurrence (ER) in pediatric inflammatory bowel disease ( ...

Abstract	Background: Ileocecectomy related to stricturing, fistula formation, or medically refractory disease is commonly required in patients with Crohn disease (CD). Limited research exists in endoscopic recurrence (ER) in pediatric inflammatory bowel disease (IBD). In this study, we sought to determine ER rates and the impact of therapy duration before surgery in pediatric patients with CD. Methods: This was a single-center retrospective review of patients with CD between the ages of 2 to 20 years who required ileocecectomy between January 2015 and December 2019 at Nationwide Children's Hospital. Follow-up endoscopies, laboratory values, medications, and sPCDAI scores were recorded at 6, 12, 24, and 36 months post-resection wherever available. Modified Rutgeert scores (mRS) were independently assigned to post-resection colonoscopy images by 3 trained investigators. Post-resection outcomes were compared between patients on CD therapy >30 days before resection (late surgery) to those started on CD therapy <30 days before resection (early surgery). Results: A total of 48 patients underwent ileocecectomy, with a mean age at time of resection of 17 years (+/-2.3). In total, 88% of patients had a post-resection endoscopy and 57% had an endoscopy within 12 months of resection. Twenty-nine percentage had ER with a mRS ≥i2. There was no statistical difference in endoscopic and clinical outcomes after resection between the early and late surgery groups. Conclusions: Post-resection endoscopic recurrence after ileocecectomy was found in 29% of our center's pediatric CD population based on mRS. Post-resection outcomes were not affected by therapy duration before resection.
MeSH term(s)	Adolescent ; Adult ; Cecum ; Child ; Child, Preschool ; Colonoscopy ; Crohn Disease/drug therapy ; Humans ; Ileum/surgery ; Recurrence ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2022-04-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1097/MPG.0000000000003456
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Article ; Online: Outcomes for Standardized Home and Hospital-Based Infusions of Infliximab for Children With Inflammatory Bowel Disease.

Gupta, Shivani R / Bricker, Josh / Boyle, Brendan M / Maltz, Ross M / Michel, Hilary K / Dotson, Jennifer L

Journal of pediatric gastroenterology and nutrition

2023 Volume 76, Issue 6, Page(s) 776–781

Abstract: Background: Pediatric inflammatory bowel disease (IBD) is commonly treated with infliximab in a hospital setting. Utilization of home infusions (HI) is increasing due to insurance mandates, travel time savings, and convenience. We evaluated adverse ... ...

Abstract	Background: Pediatric inflammatory bowel disease (IBD) is commonly treated with infliximab in a hospital setting. Utilization of home infusions (HI) is increasing due to insurance mandates, travel time savings, and convenience. We evaluated adverse outcomes (AOs) of infliximab infusions in children with IBD receiving HI compared to hospital-based infusions. Methods: Children receiving HI between September 2016 and September 2018 were retrospectively matched based on age, race, ethnicity, sex, and disease type to a cohort receiving infliximab at a hospital-based center. A survival analysis evaluated the hazard ratio for AOs in HI relative to hospital-infused children over 2 years. AOs were defined as discontinuation of therapy for clinically relevant reasons, IBD-related hospitalizations, and emergency department visits. Results: We included 102 children (51 pairs) (63% male, 91% White, 92% Crohn disease). Disease location, behavior, growth status, and disease severity were similar between the 2 cohorts. Quiescent disease increased from 3% to 93% after 2 years without cohort differences. At baseline, 94% of HI patients and 88% of controls were on 5 mg/kg every 8 weeks as standard maintenance therapy. Within 2 years, only 19% remained on 5 mg/kg and the remainder required increased dosing or decreased interval. The HI cohort had fewer labs obtained ( P < 0.001), though laboratory values, number of clinic visits, and frequency of AOs were similar. Conclusion: Drug durability, AOs, and laboratory values were similar between HI and hospital-based infusions. These findings suggest HI may be as effective as hospital-based infusions, provided a standardized care approach is utilized.
MeSH term(s)	Humans ; Male ; Child ; Female ; Infliximab ; Retrospective Studies ; Gastrointestinal Agents ; Inflammatory Bowel Diseases/drug therapy ; Infusions, Intravenous ; Hospitals
Chemical Substances	Infliximab (B72HH48FLU) ; Gastrointestinal Agents
Language	English
Publishing date	2023-03-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1097/MPG.0000000000003772
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Article ; Online: Diagnosis and Treatment of Iron Deficiency and Anemia in Youth With Inflammatory Bowel Disease.

Smith, Jennifer / Jacobson-Kelly, Amanda / Donegan, Amy / Boyle, Brendan / Maltz, Ross M / Michel, Hilary K / Dotson, Jennifer L

Journal of pediatric gastroenterology and nutrition

2022 Volume 76, Issue 3, Page(s) 313–318

Abstract: Objectives: Iron deficiency (ID) with and without anemia is prevalent in children and adults diagnosed with inflammatory bowel disease (IBD), but often goes unrecognized. We hypothesized, quality improvement (QI) methodology could increase the screening ...

Abstract	Objectives: Iron deficiency (ID) with and without anemia is prevalent in children and adults diagnosed with inflammatory bowel disease (IBD), but often goes unrecognized. We hypothesized, quality improvement (QI) methodology could increase the screening for and treatment of ID in children newly diagnosed with IBD. Methods: We developed and implemented an easy-to-follow algorithm to facilitate screening for and treatment of ID for patients diagnosed with IBD. Through a series of Plan-Do-Study-Act cycles, the approach was modified to increase screening and treatment of ID. Data between January 2019 and July 2021 were assessed using statistical process control. Results: Among patients newly diagnosed with IBD, 298 patients were included (67% Crohn disease, 29% ulcerative colitis, 4% indeterminate colitis, and 56% males). Rates of ID screening increased significantly from a baseline of 20% to >90%. Of the 232 patients screened for ID during the improvement period, 205 (88%) met criteria for either iron deficiency anemia (IDA) or ID at diagnosis, specifically, 151 (65%) met criteria for IDA and 54 (23%) met criteria for ID. Conclusions: Use of QI methodology to standardize screening assessments for ID among children newly diagnosed with IBD improved screening rates from a baseline of 20% to >90%, with 88% of patients found to have IDA or ID.
MeSH term(s)	Male ; Adult ; Child ; Humans ; Adolescent ; Female ; Inflammatory Bowel Diseases/complications ; Iron Deficiencies ; Colitis, Ulcerative/complications ; Colitis, Ulcerative/diagnosis ; Anemia ; Crohn Disease/complications ; Crohn Disease/diagnosis ; Anemia, Iron-Deficiency/diagnosis ; Anemia, Iron-Deficiency/etiology ; Anemia, Iron-Deficiency/therapy
Language	English
Publishing date	2022-11-30
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1097/MPG.0000000000003673
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Article ; Online: Clinical outcomes and cost savings of a nonmedical switch to a biosimilar in children/young adults with inflammatory bowel disease.

McNicol, Megan / Abdel-Rasoul, Mahmoud / McClinchie, Madeline G / Morris, Grant A / Boyle, Brendan / Dotson, Jennifer L / Michel, Hilary K / Maltz, Ross M

Journal of pediatric gastroenterology and nutrition

2024 Volume 78, Issue 3, Page(s) 644–652

Abstract: Objectives: The safety, efficacy, and cost savings associated with biosimilar medications are well established. However, a lack of pediatric data exists surrounding clinical outcomes when switching from an originator to a biosimilar. Our primary aim is ... ...

Abstract	Objectives: The safety, efficacy, and cost savings associated with biosimilar medications are well established. However, a lack of pediatric data exists surrounding clinical outcomes when switching from an originator to a biosimilar. Our primary aim is to evaluate clinical outcomes following a nonmedical switch from the infliximab originator to a biosimilar in children and young adults with inflammatory bowel disease (IBD). Our secondary aim is to estimate cost savings associated with this switch. Methods: A quality improvement project was implemented to establish safe switching protocols, then those patients who underwent a nonmedical switch from the infliximab originator to the biosimilar were retrospectively reviewed. Demographic data, physician global assessments (PGAs), and laboratory values were recorded 1 year pre- and post-switch. Continuation rates on the biosimilar were reported at 6 and 12 months. Cost savings were estimated using two different pricing models. Results: Fifty-three patients underwent a nonmedical switch. Laboratory values including inflammatory markers, infliximab levels, and PGA scores remained similar when assessed pre- and post-switch. No infusion reactions or antidrug antibody development occurred. Two patients reported psoriasis-like rashes. Five patients switched back to the originator during the study period. There were 379 biosimilar infusions completed with an estimated total cost savings of $11,260 (average sales price) and $566,223 (wholesale acquisition cost). Conclusions: Clinical remission rates, inflammatory laboratory markers, serious adverse events, infliximab levels, and antidrug antibodies remained similar after a one-time nonmedical switch to an infliximab biosimilar. Nonmedical switching to biosimilars resulted in significant cost savings.
MeSH term(s)	Humans ; Young Adult ; Child ; Infliximab/therapeutic use ; Biosimilar Pharmaceuticals/therapeutic use ; Antibodies, Monoclonal/therapeutic use ; Retrospective Studies ; Cost Savings ; Inflammatory Bowel Diseases/drug therapy ; Treatment Outcome ; Gastrointestinal Agents/therapeutic use
Chemical Substances	Infliximab (B72HH48FLU) ; Biosimilar Pharmaceuticals ; Antibodies, Monoclonal ; Gastrointestinal Agents
Language	English
Publishing date	2024-02-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1002/jpn3.12153
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Article ; Online: 6- and 12-Month Outcomes after 90:10 Enteral Nutrition Induction Therapy in Pediatric Crohn's Disease.

Davidson, Nicole / Rutsky, Jessica / Bricker, Josh B / Smith, Jennifer / Maltz, Ross M / Dotson, Jennifer L / Michel, Hilary K / Boyle, Brendan

Journal of pediatric gastroenterology and nutrition

2022 Volume 75, Issue 1, Page(s) 70–75

Abstract: Objectives: Studies describing longer-term outcomes after EEN induction are limited. We describe clinical outcomes during 90:10 EN induction, and 6- and 12- month outcomes among patients that successfully completed EN induction and then continued either ...

Abstract	Objectives: Studies describing longer-term outcomes after EEN induction are limited. We describe clinical outcomes during 90:10 EN induction, and 6- and 12- month outcomes among patients that successfully completed EN induction and then continued either EN or immunomodulator (IM) maintenance therapy. Methods: All children with CD treated with 90:10 EN induction protocol (90% formula:10% regular diet) at our IBD Center from 2013 to 2018 were retrospectively reviewed. Demographic, clinical, and laboratory data were recorded at baseline, 6, and 12 months (± 3 months at each timepoint). Therapy changes after initiation of EN induction through 12 months were recorded. Among patients that successfully completed 90:10 induction, outcomes between EN and IM maintenance groups were compared. Results: In total, 44/105 (42%) patients completed 8-12 weeks of 90:10 EN induction. Sixty-one patients had incomplete EN induction, with 52% requiring corticosteroids and 25% anti-TNF therapy as alternate induction approaches. Forty-four patients completed EN induction (18 continued EN maintenance and 26 IM maintenance therapy). Twenty-seven of these 44 (61%) remained on initial maintenance therapy at 6 months (10/18 (56%) EN and 17/26 (65%) IM). In total, 16/44 (36%) remained on their initial maintenance therapy at 12 months. By 12 months, 10 patients required anti-TNF and 11 corticosteroids after successful completion of induction. Conclusions: In this retrospective study of short and longer-term outcomes after 90:10 EN induction, the need for an alternate induction therapy was common, most frequently to anti-TNF or corticosteroid therapy. Future studies are needed to evaluate for predictors of long-term success after EN induction.
MeSH term(s)	Adrenal Cortex Hormones/therapeutic use ; Child ; Crohn Disease ; Enteral Nutrition/methods ; Humans ; Induction Chemotherapy ; Remission Induction ; Retrospective Studies ; Tumor Necrosis Factor Inhibitors
Chemical Substances	Adrenal Cortex Hormones ; Tumor Necrosis Factor Inhibitors
Language	English
Publishing date	2022-05-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1097/MPG.0000000000003475
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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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Full text online

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

Order via subito