Outcomes Following Acute Severe Colitis at Initial Presentation: A Multi-centre, Prospective, Paediatric Cohort Study
To assess contemporary outcomes in children with acute severe ulcerative colitis [ASUC] at initial presentation. Between April 2014 and January 2019, children aged
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| Veröffentlicht in: | Journal of Crohn's and colitis 2024-02, Vol.18 (2), p.233-245 |
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| creator | Dhaliwal, Jasbir Tertigas, Dominique Carman, Nicholas Lawrence, Sally Debruyn, Jennifer C Wine, Eytan Church, Peter C Huynh, Hien Q Rashid, Mohsin El-Matary, Wael Deslandres, Colette Critch, Jeffrey Ricciuto, Amanda Carroll, Matthew W Benchimol, Eric I Muise, Aleixo Jacobson, Kevan Otley, Anthony R Vallance, Bruce Mack, David R Walters, Thomas D Surette, Michael G Griffiths, Anne M |
| description | To assess contemporary outcomes in children with acute severe ulcerative colitis [ASUC] at initial presentation.
Between April 2014 and January 2019, children aged |
| doi_str_mv | 10.1093/ecco-jcc/jjad143 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10896636</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2854346805</sourcerecordid><originalsourceid>FETCH-LOGICAL-c397t-540ad9d1287ecebe39cb48a0c435f78f83b7b750080573dd32cc9e60907f54b13</originalsourceid><addsrcrecordid>eNpVkU1vFDEMhiMEoqVw54Ry5NBpM5tMPrig1YpCpaIiFc5RxuNps8pOliSzqP-ebLut4GQ7tl-_ykPI-5adtczwcwSIzRrgfL12Qyv4C3LcaiUbIZR5-ZDzxhghj8ibnNeMdaZT-jU54kqyhZHmmMzXc4G4wUwvYgjxj59u6RLmgvQGd5iQrmLwxWfqCr2cauYC_ZEw41Rc8XH6RJf0-xyKb6A-JTyt3Zi3CMXv9oXDwbuSPFShu5gKvSnzcP-WvBpdyPjuEE_Ir4svP1ffmqvrr5er5VUD3KjSdIK5wQztQisE7JEb6IV2DATvRqVHzXvVq44xzTrFh4EvAAxKZpgaO9G3_IR8ftTdzv0GhweLLtht8huX7m103v7fmfydvY072zJtpOSyKnw8KKT4e8Zc7MZnwBDchHHOdqE7wYWsBuooexyF-gM54fh8p2V2j8vucdmKyx5w1ZUP__p7Xnjiw_8CZR6WZQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2854346805</pqid></control><display><type>article</type><title>Outcomes Following Acute Severe Colitis at Initial Presentation: A Multi-centre, Prospective, Paediatric Cohort Study</title><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Dhaliwal, Jasbir ; Tertigas, Dominique ; Carman, Nicholas ; Lawrence, Sally ; Debruyn, Jennifer C ; Wine, Eytan ; Church, Peter C ; Huynh, Hien Q ; Rashid, Mohsin ; El-Matary, Wael ; Deslandres, Colette ; Critch, Jeffrey ; Ricciuto, Amanda ; Carroll, Matthew W ; Benchimol, Eric I ; Muise, Aleixo ; Jacobson, Kevan ; Otley, Anthony R ; Vallance, Bruce ; Mack, David R ; Walters, Thomas D ; Surette, Michael G ; Griffiths, Anne M</creator><creatorcontrib>Dhaliwal, Jasbir ; Tertigas, Dominique ; Carman, Nicholas ; Lawrence, Sally ; Debruyn, Jennifer C ; Wine, Eytan ; Church, Peter C ; Huynh, Hien Q ; Rashid, Mohsin ; El-Matary, Wael ; Deslandres, Colette ; Critch, Jeffrey ; Ricciuto, Amanda ; Carroll, Matthew W ; Benchimol, Eric I ; Muise, Aleixo ; Jacobson, Kevan ; Otley, Anthony R ; Vallance, Bruce ; Mack, David R ; Walters, Thomas D ; Surette, Michael G ; Griffiths, Anne M</creatorcontrib><description>To assess contemporary outcomes in children with acute severe ulcerative colitis [ASUC] at initial presentation.
Between April 2014 and January 2019, children aged <17 years, with new onset ASUC (Paediatric Ulcerative Colitis Activity Index [PUCAI ≥65) were prospectively followed in a Canadian inception cohort study. 16S rRNA amplicon sequencing captured microbial composition of baseline faecal samples. Primary endpoint was corticosteroid-free clinical remission with intact colon at 1 year [PUCAI <10, no steroids ≥4 weeks].
Of 379 children with new onset UC/IBD-unclassified, 105 [28%] presented with ASUC (42% male; median [interquartile range; [IQR]) age 14 [11-16] years; extensive colitis in all). Compared with mild UC, gut microbiome of ASUC patients had lower α-diversity, decreased beneficial anaerobes, and increased aerobes; 54 [51%] children were steroid-refractory and given infliximab [87% intensified regimen]. Corticosteroid-free remission at 1 year was achieved by 62 [61%] ASUC cohort (by 34 [63%] steroid-refractory patients, all on biologics; by 28 [55%] steroid responders,13 [25%] on 5- aminosalicylic acid [5-ASA], 5 [10%] on thiopurines, 10 [20%] on biologics). By 1 year, 78 [74%] escalated to infliximab including 24 [47%] steroid-responders failed by 5-ASA and/or thiopurines. In multivariable analysis, clinical predictors for commencing infliximab included hypoalbuminaemia, greater PUCAI, higher age, and male sex. Over 18 months, repeat corticosteroid course[s] and repeat hospitalisation were less likely among steroid-refractory versus -responsive but -dependent patients (adjusted odds ratio [aOR] 0.71 [95% CI 0.57-0.89] and 0.54 [95% CI 0.45-0.66], respectively).
The majority of children presenting with ASUC escalate therapy to biologics. Predictors of need for advanced therapy may guide selection of optimal maintenance therapy.</description><identifier>ISSN: 1873-9946</identifier><identifier>ISSN: 1876-4479</identifier><identifier>EISSN: 1876-4479</identifier><identifier>DOI: 10.1093/ecco-jcc/jjad143</identifier><identifier>PMID: 37602969</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Original</subject><ispartof>Journal of Crohn's and colitis, 2024-02, Vol.18 (2), p.233-245</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c397t-540ad9d1287ecebe39cb48a0c435f78f83b7b750080573dd32cc9e60907f54b13</citedby><cites>FETCH-LOGICAL-c397t-540ad9d1287ecebe39cb48a0c435f78f83b7b750080573dd32cc9e60907f54b13</cites><orcidid>0000-0001-7269-8557 ; 0000-0001-8623-4665 ; 0000-0002-3458-4142 ; 0000-0001-9624-3346 ; 0000-0001-8855-3598 ; 0000-0002-4184-4600 ; 0000-0002-7295-7595</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37602969$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dhaliwal, Jasbir</creatorcontrib><creatorcontrib>Tertigas, Dominique</creatorcontrib><creatorcontrib>Carman, Nicholas</creatorcontrib><creatorcontrib>Lawrence, Sally</creatorcontrib><creatorcontrib>Debruyn, Jennifer C</creatorcontrib><creatorcontrib>Wine, Eytan</creatorcontrib><creatorcontrib>Church, Peter C</creatorcontrib><creatorcontrib>Huynh, Hien Q</creatorcontrib><creatorcontrib>Rashid, Mohsin</creatorcontrib><creatorcontrib>El-Matary, Wael</creatorcontrib><creatorcontrib>Deslandres, Colette</creatorcontrib><creatorcontrib>Critch, Jeffrey</creatorcontrib><creatorcontrib>Ricciuto, Amanda</creatorcontrib><creatorcontrib>Carroll, Matthew W</creatorcontrib><creatorcontrib>Benchimol, Eric I</creatorcontrib><creatorcontrib>Muise, Aleixo</creatorcontrib><creatorcontrib>Jacobson, Kevan</creatorcontrib><creatorcontrib>Otley, Anthony R</creatorcontrib><creatorcontrib>Vallance, Bruce</creatorcontrib><creatorcontrib>Mack, David R</creatorcontrib><creatorcontrib>Walters, Thomas D</creatorcontrib><creatorcontrib>Surette, Michael G</creatorcontrib><creatorcontrib>Griffiths, Anne M</creatorcontrib><title>Outcomes Following Acute Severe Colitis at Initial Presentation: A Multi-centre, Prospective, Paediatric Cohort Study</title><title>Journal of Crohn's and colitis</title><addtitle>J Crohns Colitis</addtitle><description>To assess contemporary outcomes in children with acute severe ulcerative colitis [ASUC] at initial presentation.
Between April 2014 and January 2019, children aged <17 years, with new onset ASUC (Paediatric Ulcerative Colitis Activity Index [PUCAI ≥65) were prospectively followed in a Canadian inception cohort study. 16S rRNA amplicon sequencing captured microbial composition of baseline faecal samples. Primary endpoint was corticosteroid-free clinical remission with intact colon at 1 year [PUCAI <10, no steroids ≥4 weeks].
Of 379 children with new onset UC/IBD-unclassified, 105 [28%] presented with ASUC (42% male; median [interquartile range; [IQR]) age 14 [11-16] years; extensive colitis in all). Compared with mild UC, gut microbiome of ASUC patients had lower α-diversity, decreased beneficial anaerobes, and increased aerobes; 54 [51%] children were steroid-refractory and given infliximab [87% intensified regimen]. Corticosteroid-free remission at 1 year was achieved by 62 [61%] ASUC cohort (by 34 [63%] steroid-refractory patients, all on biologics; by 28 [55%] steroid responders,13 [25%] on 5- aminosalicylic acid [5-ASA], 5 [10%] on thiopurines, 10 [20%] on biologics). By 1 year, 78 [74%] escalated to infliximab including 24 [47%] steroid-responders failed by 5-ASA and/or thiopurines. In multivariable analysis, clinical predictors for commencing infliximab included hypoalbuminaemia, greater PUCAI, higher age, and male sex. Over 18 months, repeat corticosteroid course[s] and repeat hospitalisation were less likely among steroid-refractory versus -responsive but -dependent patients (adjusted odds ratio [aOR] 0.71 [95% CI 0.57-0.89] and 0.54 [95% CI 0.45-0.66], respectively).
The majority of children presenting with ASUC escalate therapy to biologics. 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Between April 2014 and January 2019, children aged <17 years, with new onset ASUC (Paediatric Ulcerative Colitis Activity Index [PUCAI ≥65) were prospectively followed in a Canadian inception cohort study. 16S rRNA amplicon sequencing captured microbial composition of baseline faecal samples. Primary endpoint was corticosteroid-free clinical remission with intact colon at 1 year [PUCAI <10, no steroids ≥4 weeks].
Of 379 children with new onset UC/IBD-unclassified, 105 [28%] presented with ASUC (42% male; median [interquartile range; [IQR]) age 14 [11-16] years; extensive colitis in all). Compared with mild UC, gut microbiome of ASUC patients had lower α-diversity, decreased beneficial anaerobes, and increased aerobes; 54 [51%] children were steroid-refractory and given infliximab [87% intensified regimen]. Corticosteroid-free remission at 1 year was achieved by 62 [61%] ASUC cohort (by 34 [63%] steroid-refractory patients, all on biologics; by 28 [55%] steroid responders,13 [25%] on 5- aminosalicylic acid [5-ASA], 5 [10%] on thiopurines, 10 [20%] on biologics). By 1 year, 78 [74%] escalated to infliximab including 24 [47%] steroid-responders failed by 5-ASA and/or thiopurines. In multivariable analysis, clinical predictors for commencing infliximab included hypoalbuminaemia, greater PUCAI, higher age, and male sex. Over 18 months, repeat corticosteroid course[s] and repeat hospitalisation were less likely among steroid-refractory versus -responsive but -dependent patients (adjusted odds ratio [aOR] 0.71 [95% CI 0.57-0.89] and 0.54 [95% CI 0.45-0.66], respectively).
The majority of children presenting with ASUC escalate therapy to biologics. Predictors of need for advanced therapy may guide selection of optimal maintenance therapy.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>37602969</pmid><doi>10.1093/ecco-jcc/jjad143</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0001-7269-8557</orcidid><orcidid>https://orcid.org/0000-0001-8623-4665</orcidid><orcidid>https://orcid.org/0000-0002-3458-4142</orcidid><orcidid>https://orcid.org/0000-0001-9624-3346</orcidid><orcidid>https://orcid.org/0000-0001-8855-3598</orcidid><orcidid>https://orcid.org/0000-0002-4184-4600</orcidid><orcidid>https://orcid.org/0000-0002-7295-7595</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of Crohn's and colitis, 2024-02, Vol.18 (2), p.233-245 |
| issn | 1873-9946 1876-4479 1876-4479 |
| language | eng |
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| source | Oxford University Press Journals All Titles (1996-Current) |
| subjects | Original |
| title | Outcomes Following Acute Severe Colitis at Initial Presentation: A Multi-centre, Prospective, Paediatric Cohort Study |
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