Natural History of Pediatric Patients With Crohn's Disease Treated With Mesalamine Therapy

Denise D Young; Sharon Perry; Sindhoosha Malay; Thomas J Sferra; Michael Finkler; Jonathan Moses

doi:10.1097/PG9.0000000000000379

Natural History of Pediatric Patients With Crohn's Disease Treated With Mesalamine Therapy

JPGN Rep. 2023 Nov 3;4(4):e379. doi: 10.1097/PG9.0000000000000379. eCollection 2023 Nov.

Authors

Denise D Young¹, Sharon Perry¹, Sindhoosha Malay², Thomas J Sferra¹, Michael Finkler³, Jonathan Moses¹

Affiliations

¹ From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, UH Rainbow Babies and Children's Hospital, Cleveland, OH.
² Biostastics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH.
³ Department of Pediatric Pharmacy, UH Rainbow Babies and Children's Hospital, Cleveland, OH.

Abstract

Background: 5-aminosalicylates (5-ASA) are used to treat mild to moderate ulcerative colitis. Despite their lack of efficacy in Crohn disease (CD), they are still used in real-world practice. Additionally, when patients have progressive disease, they may escalate to biologic therapy, at which time 5-ASA may or may not be discontinued.

Objectives: The aim of this study is to assess the clinical outcomes of patients started on 5-ASA for the treatment of pediatric CD. The secondary aims were to evaluate the outcomes of those who continue 5-ASA to those who discontinue 5-ASA upon biologic escalation.

Methods: We performed a single-center retrospective chart review of pediatric CD patients from 2010 to 2019 who were initially treated with 5-ASA. Demographics, medication and laboratory data, and clinical disease activity were collected.

Results: Sixty-one patients were included in the study; the majority had inflammatory CD with ileocolonic involvement. Twenty-four patients were on a concomitant immunomodulator. The majority of patients (85.2%) required escalation to biologics. Thirty-two patients (61.5%) who escalated to biologic therapy continued on 5-ASA. Eighty percent of patients achieved clinical remission at 1 year, and there was no difference between those who continued 5-ASA at time of biologic initiation compared to those who did not continue the medication. Patients who discontinued 5-ASA had an average annual cost savings of $6741.

Conclusion: 5-ASA is not a durable monotherapy for the treatment of pediatric CD. Patients who require escalation from 5-ASA to biologic therapy do not benefit from concomitant 5-ASA therapy. Further prospective studies are needed to confirm these findings.

Keywords: 5-ASA; Crohn disease; anti-TNFα; biologics; mesalamine; pediatrics.

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.