Nationwide real-world exclusive enteral nutrition practice over time: Persistence of use as induction for paediatric Crohn’s Disease and emerging combination strategy with biologics

Background: Exclusive enteral nutrition (EEN) is the recommended first-line induction treatment in paediatric patients with active luminal Crohn’s disease (CD). We aimed to provide a nationwide overview of evolving EEN practices during an era of increasing biologic use.

Methods: We analysed a prospectively identified nationwide cohort of newly diagnosed paediatric patients with CD in Scotland between 01/01/15 and 30/06/22. Patients who received EEN for any indication were divided into 6-monthly epochs and examined over time. Differences during the COVID-19pandemic (16/03/20 –19/07/21) were examined. Data were retrospectively collected from electronic medical records: demographics, anthropometrics, concomitant treatments, aspects of EEN administration and remission/response rates. Descriptive statistics and linear regression were used for analyses.

Results: A total of 649patients with CD were identified (63% male; median (IQR) age 12.6 (10.8–14.8) years); 497/649(77%) received EEN as post-diagnosis induction therapy with a median(IQR)course length of 7.7 (5.9–8.0) weeks. Including repeat courses, 547EEN courses were examined. An increasing incidence of CD was observed over time with no significant changes in EEN usage, remission or response rates, nasogastric tube usage or course completion(all p=>0.05). Increasing use of EEN combined with biologics (combination induction) as first-line induction was observed over time (p=<0.001). Considering COVID-19, lower rates of EEN usage were observed (p=0.008)with no differences in remission, oral administration and course completion rates (all p=>0.05).

Conclusions: Over the past 7.5 years, except during the COVID-19 pandemic, EEN usage rates have not changed despite an increase in biologic use, although combination induction is an emerging trend.