Corticosteroids and Azathioprine in the First Year of Crohn Disease Therapy in Children

Czech version

Authors: J. Malý; O. Pozler; P. Dědek
Authors‘ workplace: Dětská klinika FN a LF UK, Hradec Králové přednosta prof. MUDr. M. Bayer, CSc.
Published in: Čes-slov Pediat 2009; 64 (6): 271-282.
Category: Original Papers

Overview

Introduction:
In the therapy of Crohn disease (CN) in children, systemic corticoids (SCS) play an essential role together with immunosuppressive treatment with azathioprine. The former drugs represent a very efficient remedy for inducing remission and coping with subsequent relapses of the disease, the latter one contributes to maintaining the induced remission.

Objectives:
Evaluation of the administered SCS dose including the calculation of the dose in 8th, 12th and 52nd week of therapy in relation to CN activity; analysis of SCS protecting effect of azathioprine in 52nd week of treatment.

Cohort and method:
The study investigated patients fulfilling entry criteria: age of 0–19 years, CN diagnosis, prospective evaluation of the disease activity, SCS therapy during the 1st year of observation, follow-up for at least 52 weeks. CN diagnosis was established on the basis of criteria determined by the Czech coordination group for the study of chronic diseases of gastrointestinal tract in children and in 2005 - 2006 years on the basis of sc. Porto criteria.

Results:
Forty patients fulfilled the entry criteria, the age median at the time of established diagnosis was 14 years, PCDAI was 32.5 points and the duration of observation was 44.5 months. SCS therapy was initiated in the week 0 in 35 patients (87.5%), prednisone and methylprednisolone was used for the treatment of 32 patient (91.4%) with initial dose median of prednisone equivalent of 1mg/kg (0.8–2.0).

Budesonide was used in three (8.6%) of patients at the dose of 9 mg/day. Until the 12th week SCS therapy was used to treat 38 patients and dose median of prednisone equivalent decreased from 1.0 to 0.21 mg/day. The median of cumulative prednisone dose in the 12th week of therapy was 46.6 mg/kg. Remission was reached in 33 patients (86.8%), partial therapeutic response in four (10.5%). In the 52nd week of observation SCS therapy was applied to 20 patients, while 16 children belonged to the prednisone group and four children top the budesonide group. A minimal dose of prednisone equivalent, i.e. ≤0.09 mg/kg/day was used for treatment of 11 patients (68.8%) of the prednisone group. The median of annual cumulative dose (in 40 patients) was 70.1 mg/kg/year (15.0–159.6) of prednisone equivalent, i.e. 0.19 mg/kg/day. Remission was reached in 35 patients (87.5%). There were six (15% of the 40) corticoid-dependent patients. In the first year the disease relapsed in 7 (20%) patients treated with prednisone or methylprednisolone and in three (60%) patients treated with budesonide. Six patients (12.5%) of the whole cohort underwent surgery until the 52nd week. The annual cumulative dose of prednisone in the group initially treated with azathioprine was 66.3 mg/kg/year. In the group of children who have not been initially treated with azathioprine the annual cumulative dose was 66.3 mg/kg/year. In the group of children who have not been initially treated with azathioprine the annual cumulative dose reached 102.8 mg/kg/year (p=0.089)

Conclusion:
SCS treatment was highly effective for reaching remission and to cpe with a relapse of Crohn disease in children. Cumulative dose of administered conrticoids in the first year of therapy did not reach values which are associated with a negative influence on growth. The treatment with azatioprine is an indispensable and highly effective part of the therapy of nonspecific intestinal inflammations in children, con tributes of a lower exposure to SCS and increases the probability of long-term remission.

Key words:
Crohn disease, therapy of nonspecific intestinal inflammation in children, azathioprine

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Labels

Neonatology Paediatrics General practitioner for children and adolescents

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Article was published in

Czech-Slovak Pediatrics

2009 Issue 6