J Pediatr Gastroenterol Nutr. 2022 Jul 1;75(1):70-75. doi: 10.1097/MPG.0000000000003475.Epub 2022 May 27.

Nicole Davidson ¹, Jessica Rutsky ², Josh B Bricker ³, Jennifer Smith ⁴, Ross M Maltz ¹, Jennifer L Dotson ⁵, Hilary K Michel ⁶, Brendan Boyle ⁶

Author information

¹From the Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, United States.

²the Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.

³The Center for Innovation in Pediatric Practice, The Research Institute, Nationwide Children's Hospital, Columbus, OH, United States.

⁴the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, United States.

⁵the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, United States; The Center for Innovation in Pediatric Practice, The Research Institute, Nationwide Children's Hospital, Columbus, OH, United States.

⁶the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States.

Abstract

Objectives: Studies describing longer-term outcomes after EEN induction are limited. We describe clinical outcomes during 90:10 EN induction, and 6- and 12- month outcomes among patients that successfully completed EN induction and then continued either EN or immunomodulator (IM) maintenance therapy.

Methods: All children with CD treated with 90:10 EN induction protocol (90% formula:10% regular diet) at our IBD Center from 2013 to 2018 were retrospectively reviewed. Demographic, clinical, and laboratory data were recorded at baseline, 6, and 12 months (± 3 months at each timepoint). Therapy changes after initiation of EN induction through 12 months were recorded. Among patients that successfully completed 90:10 induction, outcomes between EN and IM maintenance groups were compared.

Results: In total, 44/105 (42%) patients completed 8-12 weeks of 90:10 EN induction. Sixty-one patients had incomplete EN induction, with 52% requiring corticosteroids and 25% anti-TNF therapy as alternate induction approaches. Forty-four patients completed EN induction (18 continued EN maintenance and 26 IM maintenance therapy). Twenty-seven of these 44 (61%) remained on initial maintenance therapy at 6 months (10/18 (56%) EN and 17/26 (65%) IM). In total, 16/44 (36%) remained on their initial maintenance therapy at 12 months. By 12 months, 10 patients required anti-TNF and 11 corticosteroids after successful completion of induction.

Conclusions: In this retrospective study of short and longer-term outcomes after 90:10 EN induction, the need for an alternate induction therapy was common, most frequently to anti-TNF or corticosteroid therapy. Future studies are needed to evaluate for predictors of long-term success after EN induction.