Journal of Pediatric Gastroenterology and Nutrition 70(5):p e107-e110, May 2020. | DOI: 10.1097/MPG.0000000000002662

Kandavel et al ⁽¹⁾ retrospectively investigated the value of mean corpuscular volume to white blood cell (MCV/WBC) ratio as estimates for 6-TG levels, and further as surrogate marker for thiopurine efficacy in pediatric inflammatory bowel disease (PIBD) patients treated with thiopurine in their center. Their analysis was based on 440 PIBD patients with complete blood cell count, 441 patients with ESR or CRP values, 111 patients with physician global assessment (PGA) evaluation, but only 53 patients with 6-TG levels available. No information on concomitant drugs, endoscopic findings or disease activity scores like the wPCDAI were given. The MCV/WBC ratio was poorly related to ESR and CrP and not significantly associated with the 4 categories of PGA. The concluding AuROC analysis showed poor results for prediction of quiescent disease (defined by normal PGA and ESR or CrP) by either MCV/WBC (n = 107) or 6-TG (n = 14!). In spite of these findings and major limitations of the study as pointed out in the Editorial by Bousvaros ⁽²⁾, the authors conclude “that the MCV/WBC ratio provides an accurate, easy, and low-cost alternative method for therapeutic monitoring of thiopurine medications.”

To test the reliability of MCV/WBC as “a poor man’s drug level” for thiopurine efficacy, we analyzed data from the PIBD registry of the Society for Paediatric Gastroenterology of German-speaking countries; www.gpge.eu). The registry includes data on more than 5000 children and adolescents with IBD with >50,000 documented contacts reported by >50 PIBD outpatient clinics from 2004 onwards.

Der Beitrag Lack of Correlation of Mean Corpuscular Volume to White Blood Cell Ratio to Thiopurine Levels erschien zuerst auf CEDATA GPGE – Patientenregister.

• PMID: 28604511
• DOI: 10.1097/MPG.0000000000001649

Abstract

Objectives: Perianal disease (PD) with fistula and/or abscess formation is a severe complication in Crohn disease (CD). We examined prevalence, incidence, and risk factors for PD development in a pediatric CD cohort.

Methods: Patients with CD from the prospective, multicenter registry for inflammatory bowel disease from Germany and Austria (CEDATA-GPGE) were included if diagnosed at the age of 18 years or younger, registered within 3 months after diagnosis, and having at least 2 follow-up visits within the first year of registration. We examined potential risk factors for PD with Kaplan-Meier analysis and a final Cox model considering sex, family history of inflammatory bowel disease, extraintestinal manifestations, disease location, and induction therapy (corticosteroids or nutritional therapy).

Results: Of 2406 patients with CD, 742 fulfilled inclusion criteria (59% boys, mean age at diagnosis 12.4 ± 3.4 years). PD was present at diagnosis in 41 patients (5.5%; 80.9% boys), whereas 32 patients (4.3%, 81.3% male) developed PD during follow-up (mean 2.0 ± 1.6 years). The cumulative incidence of PD at 12 and 36 months after diagnosis was 3.5% and 7.5%, respectively. Potential risk factors for PD development during follow-up were male sex (hazard ratio = 3.2, [95%; confidence interval 1.2-7.8]) and induction therapy with corticosteroids (hazard ratio = 2.5 [1.1-5.5]). Diagnostic evaluation at PD diagnosis was incomplete in 40% of affected subjects. PD resolved within 1 year in 50% of cases.

Conclusions: Approximately 10% of CD patients in our cohort suffered from PD within the first 3 years of their disease. Male sex and initial corticosteroid therapy were associated with an increased risk to develop PD after diagnosis.

Der Beitrag Incidence and Risk Factors for Perianal Disease in Pediatric Crohn Disease Patients Followed in CEDATA-GPGE Registry erschien zuerst auf CEDATA GPGE – Patientenregister.