Factors Associated with Time to Clinical Remission in Pediatric Luminal Crohn's disease: a Retrospective Cohort Study

Background and Aim: Data on factors influencing time to remission in pediatric Crohn's disease (CD) are very limited in the literature. The aim of this retrospective cohort study was to describe the trends of time to clinical remission over the past decade and to identify factors associated with time to clinical remission in children with luminal CD. Methods: Patients under 18 years old diagnosed between 2009 and 2019 were included. All data were collected from the patients' medical records. Survival analyses and linear regression models were used to assess the impact of clinical, laboratory, endoscopic, histological, and therapeutic factors on time to clinical remission. Results: A total of 654 patients were included in the study. There was no change in the time to clinical remission over the decade. Female sex in adolescents (adjusted beta regression coefficient [a beta] = 31.8 days, P = 0.02), upper digestive tract involvement (a beta = 46.4 days, P = 0.04) perianal disease (a beta = 32.2 days, P = 0.04), presence of active inflammation on biopsies at diagnosis (a beta = 46.7 days, P = 0.01) and oral 5-aminosalicylates (5-ASA) exposure (a beta = 56.6 days, P = 0.002) were associated with longer time to clinical remission. Antibiotic exposure (a beta = -29.3 days, P = 0.04), increased eosinophils (a beta = -29.6 days, P = 0.008) and combination of exclusive enteral nutrition with tumor-necrosis-factor-alpha (TNF-alpha) inhibitors as induction therapy (a beta = -36.8 days, P = 0.04) were associated with shorter time to clinical remission. Conclusion: In children with newly diagnosed Crohn's disease, time to clinical remission did not shorten during the decade. It was associated with baseline clinical and histological data and treatment strategies. Combination of enteral nutrition and TNF-alpha inhibitors was associated with faster clinical remission.