Nationwide real-world exclusive enteral nutrition practice over time: persistence of use as induction for paediatric Crohn’s Disease and emerging combination strategy with biologics

Wands, D. I. F., Gianolio, L., Wilson, D. C., Hansen, R., Chalmers, I., Henderson, P., Gerasimidis, K. and Russell, R. K. (2023) Nationwide real-world exclusive enteral nutrition practice over time: persistence of use as induction for paediatric Crohn’s Disease and emerging combination strategy with biologics. Inflammatory Bowel Diseases, (doi: 10.1093/ibd/izad167) (PMID:37619221) (Early Online Publication)

Abstract

Background: Exclusive enteral nutrition (EEN) is the recommended first-line induction treatment in pediatric patients with active luminal Crohn’s disease (CD). We aimed to provide a nationwide overview of evolving EEN practices during an era of increasing biologic use. Methods: We analyzed a prospectively identified nationwide cohort of newly diagnosed pediatric patients with CD in Scotland between January 1, 2015, and June 30, 2022. Patients who received EEN for any indication were divided into 6-monthly epochs and examined over time. Differences during the COVID-19 pandemic (March 16, 2020, to July 19, 2021) were examined. Data were retrospectively collected from electronic medical records: demographics, anthropometrics, concomitant treatments, aspects of EEN administration, and remission/response rates. Descriptive statistics and linear regression were used for analyses. Results: A total of 649 patients with CD were identified (63% male; median age 12.6 [interquartile range, 10.8-14.8] years); 497 (77%) of 649 received EEN as postdiagnosis induction therapy with a median course length of 7.7 (interquartile range, 5.9-8.0) weeks. Including repeat courses, 547 EEN courses were examined. An increasing incidence of CD was observed over time with no significant changes in EEN usage, remission or response rates, nasogastric tube usage, or course completion (all P > .05). Increasing use of EEN combined with biologics (combination induction) as first-line induction was observed over time (P < .001). Considering COVID-19, lower rates of EEN usage were observed (P = .008) with no differences in remission, oral administration, and course completion rates (all P > .05). Conclusions: Over the past 7.5 years, except during the COVID-19 pandemic, EEN usage rates have not changed despite an increase in biologic use, although combination induction is an emerging trend.

• Item Type: Articles
• Additional Information: R.K.R. and P.H. are supported by an NHS Research Scotland Career Researcher Clinician award. D.I.F.W. was supported by an Edinburgh Children’s Hospital Charity research fellowship.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Hansen, Dr Richard and Gerasimidis, Professor Konstantinos
• Authors: Wands, D. I. F., Gianolio, L., Wilson, D. C., Hansen, R., Chalmers, I., Henderson, P., Gerasimidis, K., and Russell, R. K.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Inflammatory Bowel Diseases
• Publisher: Oxford University Press
• ISSN: 1078-0998
• ISSN (Online): 1536-4844
• Published Online: 24 August 2023