Long-Term Outcomes in Pediatric Crohn’s Disease According to Induction Therapy and Early Treatment Response: A Nationwide Cohort Study

Background/Objectives: Nutritional therapy in pediatric Crohn’s disease has evolved during the last decade. Exclusive enteral nutrition (EEN) has been proven to improve nutritional status and serves as an effective induction treatment. However, its long-term benefits compared to corticosteroids (CS) remain uncertain. We aimed to assess long-term disease outcomes by induction therapy and the impact of early treatment response. Methods: This is a post hoc analysis using data from the prospective, nationwide Hungarian Pediatric IBD Registry (HUPIR). Children diagnosed with Crohn’s disease between 2011 and 2016 who initiated EEN or CS at diagnosis were included. We analyzed main outcomes such as clinical relapse, initiation of biologic therapy, and intestinal resection using interval-censored survival analysis and multivariable Cox regression models. We assessed treatment response at 3 months after diagnosis. Results: A total of 331 children (male: 193 (58%); mean (SD) age: 14.4+/−3.2 yrs) met the inclusion criteria and received either EEN (n = 115) or CS (n = 216). Biologic therapy-free survival was higher in the EEN group compared with the CS group (p = 0.025). In contrast, relapse-free and surgical-free survival did not differ between groups (p = 0.081 and p = 0.640, respectively). Non-response at 3 months to induction therapy showed lower relapse-free and biologic therapy-free survival (p = 0.005 and p < 0.001, respectively). Among responders, outcomes were comparable between EEN and CS. Conclusions: Early treatment response, rather than induction strategy, is strongly associated with long-term outcomes in pediatric Crohn’s disease, underscoring the importance of close monitoring and timely therapeutic adjustment.