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. 2025 Mar;80(3):433-439.
doi: 10.1002/jpn3.12442. Epub 2024 Dec 24.

Long-term outcome of pediatric acute severe colitis: A prospective 5-year follow-up of the PRASCO trial

Dan Lachman  1 , Esther Orlanski-Meyer  1 , Raffi Lev-Tzion  1 , Oren Ledder  1 , Amit Assa  1 , Zivia Shavit-Brunschwig  1 , Baruch Yerushalmi  2 , Marina Aloi  3 , Anne M Griffiths  4 , Lindsey Albenberg  5 , Itzhak Bar-Or  6 , Kaija-Leena Kolho  7 , Dror S Shouval  8   9 , Shlomi Cohen  10 , Dan Turner  1 , Ohad Atia  1
Affiliations

Long-term outcome of pediatric acute severe colitis: A prospective 5-year follow-up of the PRASCO trial

Dan Lachman et al. J Pediatr Gastroenterol Nutr. 2025 Mar.

Abstract

Objectives: The PRASCO trial reported the short-term superiority of an antibiotic cocktail plus intravenous corticosteroids (IVCS) over IVCS alone in children with acute severe colitis (ASC). Here, we report the extension of the PRASCO trial and the long-term outcomes of the antibiotic cocktail in ASC.

Methods: This prospective follow-up of the PRASCO trial documented disease outcomes and treatments annually through 5 years. The primary outcome was colectomy, and the secondary outcome was escalation to biologics, analyzed descriptively.

Results: A total of 26 children were included (12 receiving IVCS and 14 receiving IVCS + antibiotics), 19% of whom underwent colectomy during the follow-up period. The estimated probability of colectomy at 3, 6, and 12 months from admission were 7.1%, 7.1%, and 21% with IVCS + antibiotics and 0%, 8.3%, and 17% with IVCS. No children required colectomy after the first year of follow-up. The estimated probability of escalating to biologics were 66%, 77%, and 77% after 1, 2, and 3 years with IVCS + antibiotics and 42%, 51%, and 76% with IVCS. Clinical remission was higher in the IVCS + antibiotics group at each timepoint (e.g., 30% vs. 11% at 5-years). Delta of Pediatric Ulcerative Colitis Activity Index (PUCAI) score from baseline to day three of admission predicted future escalation to biologics (area under curves (AUC) 0.84 [95%CI 0.59-1.0]).

Conclusion: While adding antibiotics to IVCS may provide better short-term outcomes, the long-term benefits were comparable to IVCS alone. At 5 years, about one-fifth of children had undergone colectomy, and almost four-fifths had escalated to biologics, particularly during the first year after admission.

Keywords: acute severe colitis; antibiotic; biologic escalation; pediatric.

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Conflict of interest statement

Marina Aloi: For the past 3 years has received consultation fees, royalties, or honorarium from AbbVie and Pfizer. Dan Turner: For the past 3 years, has received consultation fees, research grants, royalties, or honorarium from Janssen, Pfizer, Hospital for Sick Children (Canada), Ferring, AbbVie, Takeda, Atlantic Health System, Shire, Celgene, Lilly, Roche, ThermoFisher, BMS. All the other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for the cumulative incidence of escalation to biologic therapy (A) and the need for alternative biologic therapy (B). IVCS, intravenous corticosteroids.
Figure 2
Figure 2
Rate of clinical remission during the follow‐up period, stratified by treatment groups. Clinical remission defined as Pediatric Ulcerative Colitis Activity Index (PUCAI) score < 10; intravenous corticosteroids (IVCS).
See this image and copyright information in PMC

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