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A common but ineffective treatment is setting pediatric Crohn's patients up for failure. A new prospective study finds that early use of 5-aminosalicylate (5-ASA) in children with Crohn's disease significantly reduces the durability of future biologic therapy and increases corticosteroid exposure — despite long-standing evidence that 5-ASAs don't work in this population.
Despite well-established evidence that 5-aminosalicylate (5-ASA) doesn't work in pediatric Crohn's disease (CD), a new prospective multicenter study published in Clinical Gastroenterology and Hepatology finds it's still being widely prescribed — and the consequences are significant.
Researchers analyzed data from 679 patients under 21 diagnosed with CD between 2010 and 2020. Those who received early 5-ASA therapy were far less likely to be started on biologic therapy (15.2% vs. 71.7%) and far more likely to discontinue future biologics once initiated. The problem compounds when 5-ASA use is paired with a lack of proactive therapeutic drug monitoring (TDM), which was the combination most strongly linked to biologic failure.
Key Takeaways:
Why it matters: Getting treatment right early in pediatric Crohn's is critical for long-term outcomes, growth, and development. This study sends a clear signal to clinicians: avoid 5-ASA and move toward effective therapy from the start.
