P-136 Attainment of Steroid-Free Clinical Remission and Normal Growth Among Canadian Children with Inflammatory Bowel Disease

Avoidance of chronic corticosteroid therapy is an accepted measure of quality IBD care. As part of quality improvement initiatives, the newly formed C.H.I.L.D. Foundation/CIHR Canadian Children IBD Network undertook to ascertain current rates of corticosteroid free clinical remission (SFR) and normal linear growth among Canadian children and adolescents with established ulcerative colitis (UC) and Crohn's disease (CD). During 8 weeks at participating Network sites, data were prospectively collected at consecutive ambulatory clinic visits on all patients (aged 2 to 17.9 years) with diagnosed IBD for ≥12 months. Physicians completed a brief data collection form including demographic data; IBD subtype; month/year of diagnosis; current medications; PCDAI (for CD) or PUCAI (for UC); categorical Physician Global Assessment (PGA) of current disease activity and of clinical symptom pattern in prior 6 months; any systemic steroid exposure during prior 6 months; appraisal of linear growth pattern during prior 12 months. Statistical analyses were performed using Chi-square and Mann-Whitney U tests. Five hundred seventeen patients with IBD (CD: 68%; UC: 25%; IBD-U: 7%) diagnosed >12 months were reviewed at 6 participating sites across 5 provinces. Median disease duration was 37mths (IQR 23–56). CD/UC ratios at individual sites ranged from 1.5 to 6.3. Median ages were 15.3 and 13.6 years for CD and UC respectively (P < 0.001). Sixty-four percent of CD patients and 49% of UC patients were male (chi sq P < 0.001). Based on PGA on day of visit, 73% of CD patients and 74% of UC patients had inactive disease, whereas 6% and 5%, respectively, had moderately/severely active IBD. Similarly, PCDAI and PUCAI scores were <10 in 82% of CD patients and 81% of UC patients. Nine percent of CD versus 5% of UC patients had height velocity less than -2 SD for age. Categorical assessment of disease activity patterns over the preceding 6 months (continuously quiescent in 58%, minimal activity in 27%) was also similar for CD and UC. In the preceding 6 months, 53% of patients (54% for CD; 50% for UC) were in corticosteroid-free remission (SFR) (defined as continuous absence of symptoms and normal laboratory markers of inflammation without any systemic corticosteroid exposure) and had a normal for age height velocity. The table lists corticosteroid exposure and maintenance therapy. CD and UC patients required a different therapeutic approach to achieve these similar rates of SFR (* indicates CD versus UC, P < 0.05). After at least the first year of diagnosed IBD, corticosteroid use is minimized by Canadian pediatric gastroenterologists through considerable use of biologic agents (particularly in CD) and immunomodulators. Use of 5-ASA/sulfasalazine in CD and UC appears to follow evidence-based guidelines. Although rates of sustained corticosteroid free remission with normal growth are similar for CD and UC, only in UC is this frequently achieved without immunomodulators or biologics.

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