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Background For paediatric patients with high risk of complicated Crohn’s disease (CD) [stricturing or penetrating disease], paediatric guidelines recommend upfront anti-tumor necrosis factor-alpha (ATA). Early ATA therapy has been demonstrated to result in higher steroid- and surgery-free remission rates at 1 year than induction with conventional treatment (CONV) [Exclusive Enteral Nutrition (EEN) or corticosteroids followed by immunomodulatory therapy]. However, it is unknown whether either type of induction treatment or achieving steroid free remission (SFR) at 3 months is a more important predictor of sustained SFR (SSFR) at 1 year. Therefore, we aimed to evaluate the independent effect of early ATA use after achieving induction of remission on sustained SFR (SSFR) rates at 1 year in an international prospective observational study. Methods Since January 2017, children (0–18 years) with newly-diagnosed CD were prospectively enrolled in 28 European and Asian paediatric IBD centers. Extensive demographic and clinical data were collected at baseline, and at 1, 3, 6 and 12 months. The primary outcome was SSFR at 1 year, defined as a weighted Paediatric CD Activity Index (wPCDAI) &amp;lt;12.5 without steroids at 3, 6, and 12 months. Secondary outcomes included SFR at 3 and 12 months, and treatment escalation to ATA. Outcomes were compared between the early ATA induction treatment group (defined as ATA within 3 months after diagnosis) and the CONV induction treatment group (EEN or corticosteroids), using χ 2 tests. Results Up to July 2021, 235 children with new-onset CD were included and completed at least 1 year of follow-up (61.7% male, median age 13.7 [IQR 11.4–15.0]). At 1 year, 62/203 (30.5%) achieved SSFR. Patients that received early ATA were more likely to achieve SSFR compared to patients with CONV (35/79 [44%] vs. 27/110 [25%], p=0.004). After induction treatment, 99/213 [47%] achieved SFR at 3 months. Patients with early ATA had higher rates of SFR at 3 months (48/84 [57%]) than those with CONV (51/129 [40%], p=0.012), and higher rates of low faecal calprotectin (67% vs. 17%, p&amp;lt;0.001) or low CRP (&amp;lt; 5 mg/l) (82% vs. 53%, p&amp;lt;0.001). Of those patients in SFR at 3 months, 71% achieved SSFR, which was not significantly different between those in SFR at 3 months with early ATA vs. with CONV (35/45 [78%] vs. 27/43 [63%], p=0.12). Conclusion While only one-third of paediatric CD patients achieve SSFR at 1 year, 71% of patients achieve SSFR after having achieved SFR at 3 months. Patients with early ATA had higher rates of SFR at 3 months and SSFR at 1 year than those without early ATA. Remission at 3 months was found to be more important for SSFR than type of induction treatment, highlighting the importance of initial response to induction treatment.

journal of crohn's and colitis

P146 Initial response to induction treatment more important than type of induction treatment for achieving sustained steroid free remission at 1 year in new-onset paediatric Crohn’s disease