Type of treating physician is associated with long-term disease outcome in the prospective Belgian registry of paediatric Crohn's disease (BELCRO)

L. WAUTERS (1), F. SMETS (2), E. DE GREEF (3), P. BONTEMS (4), I. HOFFMAN (5), P. ALLIET (6), W. ARTS (7), S. VAN BIERVLIET (8), I. PAQUOT (9), E. VAN DE VIJVER (10), B. HAUSER (3), H. PEETERS (11), M. DE VOS (12), P. BOSSUYT (13), J. RAHIER (14), T. MOREELS (15), O. DEWIT (15), D. FRANCHIMONT (16), V. MULS (16), F. FONTAINE (17), E. LOUIS (17), J. COCHE (18), F. BAERT (19), S. VERMEIRE (20), G. VEEREMAN (3) / [1] University Hospitals Leuven, Leuven, Belgium, Gastroenterology and Hepatology, [2] Clin universitaires St-Luc, UCL, Brussels, Belgium, Pediatric Gastroenterology, [3] UZ Brussel, Jette, Belgium, Pediatric Gastroenterology, [4] HUDERF, City of Brussels, Belgium, Pediatric Gastroenterology, [5] University Hospitals Leuven, Leuven, Belgium, Pediatric Gastroenterology, [6] Jessa Hospital, Hasselt, Belgium, Pediatric Gastroenterology, [7] ZOL, Genk, Belgium, Pediatric Gastroenterology, [8] UZ Gent, Gent, Belgium, Pediatric Gastroenterology, [9] CHC, Liege, Belgium, Pediatric Gastroenterology, [10] UZ Antwerpen, Antwerp, Belgium, , Belgium, Pediatric Gastroenterology, [11] AZ St Lucas, Ghent, Belgium, Gastroenterology, [12] UZ Gent, Gent, Belgium, Gastroenterology, [13] Imelda Hospital, Bonheiden, Belgium, Gastroenterology, [14] UCL, Mont-Godinne, Belgium, Gastroenterology, [15] Clin universitaires St-Luc, UCL, Brussels, Belgium, Gastroenterology, [16] ULB Hopital Erasme, Brussels, Belgium, Gastroenterology, [17] CHU Liege, Liege, Belgium, Gastroenterology, [18] Clinique St. Pierre, Ottignies, Belgium, Gastroenterology, [19] Heilig Hart Ziekenhuis, Roeselare, Belgium, Gastroenterology, [20] University Hospitals Leuven, Leuven, Belgium, Gastroenterology Introduction Treatment and outcomes in paediatric Crohn’s disease (CD) have not been compared between treating physician and centre of care. Aim Treatment and outcomes in paediatric Crohn’s disease (CD) have not been compared between treating physician and centre of care. Methods Data from the BELCRO, an observational prospective cohort of children (< 18 yrs) diagnosed with CD in Belgium, were analysed. Disease severity was scored as inactive, mild and moderate-to-severe using a 3-point scale and monitored yearly. Remission was defined as inactive disease and sustained remission when achieved for ≥ 2 yrs follow-up (FU). Univariate analyses were performed between paediatric or adult and secondary or tertiary centre of care. Results A total of 91 children (median (IQR) age 12.7 (10.9 – 14.8) yrs, 53% male) were included. Disease location was 12% ileal, 23% colonic, 64% ileocolonic, 76% upper GI or 66% proximal (L4A) and 30% perianal. Disease severity at diagnosis was 25% mild and 75% moderate-to-severe. Level of care was 70% paediatric and 71% tertiary. Younger age (11.9 (9.8 – 13.4) vs. 15.1 (13.8 – 16.7) yrs; p< 10-7) and location L4A (77% vs. 41%; p= .02) were associated with paediatrics. Young age was associated with lower disease severity (11.4 (8.7 - 13.8) yrs for mild and 13.2 (11.6 – 15.3) yrs for moderate-to-severe; p= .02). Time to biological (1.5 (0.7 – 2.6) vs. 0.6 (0.4 – 1.4); p= .003) and combination (18.5 (8.0 – 32.5) vs. 7.0 (3.0 – 12.0); p= .006) therapy was longer and duration on biologicals (3.6 (2.0 – 4.4) vs. 4.6 (2.6 – 5.0); p= .01) was shorter in paediatrics. Biological (60% vs. 26%; p= .008) and combination (65% vs. 26%: p= .005) therapy were initiated more often after first remission by paediatricians. Rate of sustained remission (95% vs. 67%; p< .001) was higher for paediatric but similar for tertiary care. Time to first (0.7 (0.3 - 1.4) vs. 1.2 (0.7 – 2.5); p= .01) and sustained (2.6 (2.1 – 3.2) vs. 3.1 (2.5 – 3.9); p< .05) remission was shorter and duration of sustained remission (2.8 (1.6 – 4.2) vs. 2.1 (1.3 – 3.5); p= .004) was longer in paediatrics. Mean disease severity during 5 yrs FU (1.5 (1.3 – 1.8) vs. 1.8 (1.6 – 2.0); p= .008) was lower in paediatrics. Rate of inactive disease after 5 yrs of FU (73% vs. 56%; p= .09) was similar with more ongoing immunomodulator treatment (56% vs. 33%; p< .05) in paediatric compared to adult care. Conclusions Paediatric care is associated with longer delay to and shorter duration on biological or combination therapy with better disease control, using a step-up approach. However, outcomes after 5 years are similiar with adult care and use of top-down strategies for more severe disease course in older patients.