P068 Therapeutic Aspects in Pediatric Inflammatory Bowel Disease--A Multicentric Study from Brazil

P068  Therapeutic Aspects in Pediatric Inflammatory Bowel Disease--A Multicentric Study from Brazil

Bordin Jaqueline1, Coronel Juliana2, dos Santos Beatriz3, Dias Caroline1, Nunes Daltro4, Pinto Raquel5, Ceza Marília2, Goldani Helena2, Ferreira Cristina Helena1, Scheeffer Vanessa1
1 Hospital da Criança Santo Antônio, Porto Alegre, Brazil, 2 Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil, 3 Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, 4 Hospital de Clinicas de Porto Alegre, R. Ramiro Barcelos, Porto Alegre, Brazil, 5 Hospital Nossa Senhora da Coinceição, Porto Alegre, Brazil

BACKGROUND: Pediatric inflammatory bowel disease (PIBD) often presents as an extensive and aggressive disease and may be complicated by fistulas and stenosis. Therapy with immunosuppressants and biologicals may prevent complications and avoid corticosteroid use. There is a lack of studies in the Brazilian pediatric population.

METHODS: Records from three reference centers from a city in the south of Brazil were researched and 96 patients with PIBD were identified. We aimed to describe aspects regarding treatment choices for PIBD used in this population. Patients were seen between 2014 and 2019 and data regarding disease aspects were collected. Statistical data analysis was performed using
SPSS 22.0 (IBM, Armonk,NY,USA). For all analyses, P < 0.05 was considered significant.

RESULTS: Ninety-six patients (51% females) with PIBD were included, 58.3% of these had CD, 34.4% had UC and 7.3% had IBD-U. Initial treatment prescribed for Crohn’s disease (CD) most common was corticosteroid + immunosuppressant (41.1%) and for ulcerative colitis (UC) was Corticosteroid + 5-ASA in 60.6% and monotherapy with 5-ASA in 21.2%. Other medications were used in lesser proportions. During follow up, 83.9% of patients with CD and 66.7% of patients with UC required treatment modification (p=0.105) and change in medication occurred in a median of once in both groups (p=0.498). Treatment failure was the leading cause of medication change, occurring in 53.2% of patients with DC and 59.1% in UC.  Recurrent use of corticosteroids (27.7% in CD and 27.3% in UC) followed by treatment de-escalation (29.8% in DC and 22.7% in UC) were also causes of treatment modification.
Currently, 21.4% of patients with CD use immunosuppressants as monotherapy and 44.6% use biologicals as monotherapy compared to UC, where 0% and 3% use immunosuppressants or biologicals as monotherapy (p=<0.001).
In UC, 30.3% use 5-aminoscalicyclic acid (5-ASA) as monotherapy, 15.2% require combined therapy with 5-ASA and immunosuppressants and 9.1% require combined therapy with biological, immunosuppressants and 5-ASA. Corticosteroids are still being used in combination with 5-ASA in 24.2% of this sample.
Median time until biological prescription was 14 months and 15.9 in CD and UC respectively (p= 0.511). 
 

CONCLUSION(S): In this study, most patients required treatment modification, most cases due to lack of response. This finding highlights the severity of PIBD, where immunosuppression and combined therapy are often required. Monotherapy was statically more frequent in CD than UC. This probably reflects a misconception in terms of immunosuppression in UC. Use of corticosteroids was also more frequently seen in UC than CD.