From the Guidelines
The long-term outlook for severe advanced Crohn's disease beginning in the teens is challenging, but with modern treatments, patients can achieve a reasonable quality of life, albeit with a chronic disease course requiring lifelong management. According to the consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease 1, children and adolescents with Crohn’s disease present often with a more complicated disease course compared to adult patients. Key factors that may predict a poor disease outcome include severe perianal fistulizing disease, severe stricturing/penetrating disease, severe growth retardation, panenteric disease, and persistent severe disease despite adequate induction therapy.
In terms of treatment, exclusive enteral nutrition (EEN) is recommended as the induction therapy of first choice for children and adolescents who have not finished their growth, due to its excellent safety profile and effectiveness in inducing remission 1. The majority of patients with pediatric-onset CD will require immunomodulator-based maintenance therapy. For those with severe disease, an anti-TNF-based top-down approach may be considered, which can include biologics like infliximab or adalimumab.
Some key considerations for managing severe advanced Crohn's disease in teens include:
- Close monitoring for growth delays and nutritional deficiencies
- Prompt diagnosis and treatment to optimize long-term prognosis
- Comprehensive care, including psychological support, to address the impact of the disease on educational achievement, career choices, and family planning
- A multidisciplinary approach to manage complications like strictures, fistulas, or abscesses, which may require surgery in approximately 70-80% of patients over their lifetime.
Overall, while the long-term outlook for severe advanced Crohn's disease beginning in the teens is complex, early aggressive treatment and comprehensive care can significantly improve quality of life and reduce the risk of complications.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Long-term Outlook for Severe Advanced Crohn's Disease Beginning in the Teens
- The long-term outlook for severe advanced Crohn's disease beginning in the teens is complex and depends on various factors, including disease severity, treatment response, and patient characteristics 2.
- Early and effective control of inflammation is critical to prevent long-term complications, such as fibrotic strictures, enteric fistulae, and intestinal neoplasia 3.
- Treatment options for Crohn's disease include steroids, monoclonal antibodies, immunomodulators, and surgery, and the choice of treatment depends on disease severity, patient risk stratification, and clinical factors 3, 4.
- Immunomodulators, such as thiopurines and methotrexate, can be effective in maintaining remission and suppressing anti-biologic antibodies when used in combination with biologics 4.
- However, the use of immunomodulators is limited by their clinical limitations, including adverse reactions and potential toxicity 3, 4.
- Aminosalicylates, such as sulfasalazine and mesalamine, have modest efficacy in inducing remission or response in mildly to moderately active Crohn's disease, but are inferior to corticosteroids and biologics 5, 6.
- The management of Crohn's disease in adolescents should address adolescent-specific characteristics and treatment goals, including optimizing growth, pubertal development, and social functioning 2.
- The condition can have a significant impact on an individual's mental and emotional wellbeing, as well as their physical health, and requires a comprehensive treatment approach that addresses these aspects 2.