Abstract
Background
IMPACT is the only validated pediatric inflammatory bowel disease (IBD) disease-specific health-related quality of life (HRQOL) questionnaire. As one form of patient-reported outcome, HRQOL is an increasingly important measure of treatment effectiveness and adverse effects in pediatric patients with Crohn’s disease (CD).
Aims
To assess whether type of induction therapy for CD had an effect on HRQOL as measured by IMPACT between three and nine months following initial treatment.
Methods
Data was obtained from the Canadian Children IBD Network (CIDsCaNN) inception cohort study, which is a multi-centre, prospective study of children aged ≤17 years with IBD. Data was extracted for patients with CD who received steroids or exclusive enteral nutrition (EEN) as induction therapy. IMPACT is reported as both total and domain scores (well-being, social, emotional, and body image). A higher score on IMPACT indicates a better HRQOL. Differences were compared between groups using independent samples t-tests, Mann-Whitney U tests, or chi-square tests, as appropriate.
Results
At the time of this analysis, 337 patients with CD had received steroids (N=169) or EEN (N=168) as initial induction therapy. Patients in both groups were similar in age (15.0±3.0 years), and gender distribution (approximately 41% female). Preliminary analysis found that, at baseline, those who began EEN had similar disease activity as measured by the Pediatric Crohn’s Disease Activity Index (55.5±23.6) compared to those on steroids (59.3±23.2) (p>0.05). The two groups did show a significant difference in disease location (p=0.01); there was a greater proportion of patients receiving steroids with L4 disease compared to those on EEN (p=0.03). Conversely, there was a greater proportion of patients receiving EEN with L3+L4 disease than those on steroid induction (p=0.01). There was no statistically significant difference between these two groups in school days missed in the last 6 months, extra-intestinal manifestations or perianal involvement.
Within the subgroup of patients who had completed IMPACT between three and nine months following induction therapy, HRQOL scores were similar (see table). There were no differences in number of hospitalizations or surgeries within 3 months of IMPACT completion between groups.
Conclusions
For pediatric patients receiving either EEN or steroids for induction therapy for CD, there was a significant difference in disease location at baseline, but similar HRQOL outcomes over time.
| Treatment/IMPACT (mean±SD) | Total | Well-being | Social | Emotional | Body Image |
|---|---|---|---|---|---|
| EEN (n=31) | 74.4±10.7 | 75.7±13.8 | 78.1±9.9 | 68.3±18.6 | 75.8±16.8 |
| Steroid (n=33) | 71.2±9.4 | 71.8±12.4 | 76.0±8.9 | 65.2±19.2 | 74.2±16.2 |
Funding Agencies
CIHRCH.I.L.D. Foundation