title: Immediate and long-term outcomes of corticosteroid therapy in pediatric Crohn's disease patients.
abstract: BACKGROUND
  Although a mainstay of treatment of moderate to severe Crohn's disease (CD), corticosteroids use presents significant challenges because of large interindividual variability in response. Corticosteroid-dependence is of particular concern in children, where high rates have been reported. We examined the burden of corticosteroid-resistance and dependence in a well-characterized cohort of pediatric CD patients and investigated potential predictors of response.
  
  
  METHODS
  Children diagnosed with CD (<18 years), were recruited from two Canadian pediatric gastroenterology clinics. Immediate and long-term responses to corticosteroid therapy were retrospectively ascertained. Response rates (resistance and dependence) were estimated and potential predictors assessed using logistic regression analysis.
  
  
  RESULTS
  Of the 645 CD patients, 364 (56.2%) received corticosteroids. The frequency of corticosteroid-resistance was (8.0%) (95% confidence interval [CI]: 5.0%-11%) and 40.9% (95% CI: 39.0%-46.0%) became dependent. In univariate analysis female gender (odds ratio [OR] = 2.49, 95% CI: 1.1-5.5, P = 0.025), disease severity (OR = 2.43, 95% CI: 1.10-5.38, P = 0.029), and complicated disease (OR = 2.75, 95% CI: 1.18-6.41, P = 0.019) were associated with resistance. In multivariate analysis lower age at diagnosis (OR = 1.34,95% CI: 1.03-3.01, P = 0.040), coexisting upper digestive tract involvement (OR = 1.35, 95% CI: 1.06-3.07, P = 0.031), and concomitant immunomodulator use (OR = 0.35, 95% CI: 0.16-0.75, P = 0.007) were significantly associated with steroid dependency.
  
  
  CONCLUSIONS
  Our results demonstrate that steroid dependency is a frequent complication in children with CD. Children with an earlier age at diagnosis and coexisting upper digestive tract involvement could be potentially targeted for steroid-sparing therapy.
authors.affiliation: Research Centre, Ste-Justine Hospital, Montreal, Quebec, Canada.
authors.forename: Alfreda
authors.initials: A
authors.lastname: Krupoves
authors.forename: David R
authors.initials: DR
authors.lastname: Mack
authors.forename: Ernest G
authors.initials: EG
authors.lastname: Seidman
authors.forename: Colette
authors.initials: C
authors.lastname: Deslandres
authors.forename: Vytautas
authors.initials: V
authors.lastname: Bucionis
authors.forename: Devendra K
authors.initials: DK
authors.lastname: Amre
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002170:Canada; D002648:Child; D015331:Cohort Studies; D003424:Crohn Disease / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011241:Prednisone / Q000627:therapeutic use*; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D011241:Prednisone