title: Effect of early immunomodulator use in moderate to severe pediatric Crohn disease.
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.
authors.affiliation: Nationwide Children's Hospital, Ohio State University, Columbus, Ohio 43210, USA. Jaya.Punati@NationwideChildrens.org
authors.forename: Jaya
authors.initials: J
authors.lastname: Punati
authors.forename: James
authors.initials: J
authors.lastname: Markowitz
authors.forename: Trudy
authors.initials: T
authors.lastname: Lerer
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hyams
authors.forename: Subra
authors.initials: S
authors.lastname: Kugathasan
authors.forename: Anne
authors.initials: A
authors.lastname: Griffiths
authors.forename: Anthony
authors.initials: A
authors.lastname: Otley
authors.forename: Joel
authors.initials: J
authors.lastname: Rosh
authors.forename: Marian
authors.initials: M
authors.lastname: Pfefferkorn
authors.forename: David
authors.initials: D
authors.lastname: Mack
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: M Susan
authors.initials: MS
authors.lastname: Moyer
authors.forename: Robert
authors.initials: R
authors.lastname: Wyllie
authors.forename: Maria
authors.initials: M
authors.lastname: Oliva-Hemker
authors.forename: Adam
authors.initials: A
authors.lastname: Mezoff
authors.forename: Neal
authors.initials: N
authors.lastname: Leleiko
authors.forename: David
authors.initials: D
authors.lastname: Keljo
authors.forename: Wallace
authors.initials: W
authors.lastname: Crandall
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001379:Azathioprine / Q000008:administration & dosage; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D000069285:Infliximab; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage; D011446:Prospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D007155:Immunologic Factors; D000069285:Infliximab; D015122:Mercaptopurine; D001379:Azathioprine