What question did this study set out to answer?

This study aims to compare the effectiveness and safety of enteral nutrition against immunomodulators for treating pediatric Crohn's disease.

April 26, 2026Open Access

Enteral nutrition versus immunomodulators for induction and maintenance of remission in pediatric Crohn's disease: a systematic review and network meta-analysis

JCJiajia ChenChengdu Women's and Children's Central Hospital KYKeying YangChengdu Women's and Children's Central Hospital ZQZhang QiongyueChengdu Women's and Children's Central Hospital

Key Points

This study aims to compare the effectiveness and safety of enteral nutrition against immunomodulators for treating pediatric Crohn's disease.
Systematic search of PubMed, Embase, Cochrane CENTRAL, and Web of Science;
Included randomized controlled trials and observational studies of EN and immunomodulators;
Conducted frequentist network meta-analysis with random-effects models.
EEN is significantly more effective than corticosteroids for clinical remission induction (OR 1.72; 95% CI 1.18–2.52).
EEN shows marked superiority for mucosal healing versus corticosteroids (OR 7.55; 95% CI 3.59-15.88).
Safety profiles for enteral nutrition therapies were favorable, with serious adverse event rates between 0% and 3.1%, compared to 15.1% for corticosteroids.

Abstract

Background Enteral nutrition (EN) and immunomodulators are established therapies for pediatric Crohn's disease (CD), yet comparative effectiveness data remain limited. Objective We conducted a network meta-analysis (NMA) to compare the efficacy and safety of EN therapies vs. immunomodulators and corticosteroids for remission induction and maintenance in pediatric CD. Methods We systematically searched PubMed, Embase, Cochrane CENTRAL, and Web of Science from inception through October 2024. Randomized controlled trials (RCTs) and comparative observational studies evaluating exclusive enteral nutrition (EEN), partial enteral nutrition (PEN), Crohn's Disease Exclusion Diet plus PEN (CDED + PEN), supplemental enteral nutrition (SEN), corticosteroids (CS), azathioprine/6-mercaptopurine (AZA/6-MP), or methotrexate (MTX) were included. Primary outcomes were clinical remission and mucosal healing. Frequentist NMA was performed using random-effects models. Surface under the cumulative ranking curve (SUCRA) values determined treatment rankings. Results Twenty studies (7 RCTs, 13 observational) comprising 1,182 patients were included. For clinical remission induction, EEN was significantly superior to CS odds ratio [OR 1.72; 95% confidence interval CI 1.18–2.52; 7 studies; I 2 = 0%]. EEN demonstrated marked superiority for mucosal healing vs. CS (OR 7.55; 95% CI 3.59-15.88). SUCRA rankings for remission induction were: CDED + PEN (0.80), EEN (0.78), MTX (0.55), AZA/6-MP (0.47), CS (0.31), and PEN (0.08). For maintenance, AZA/6-MP was superior to placebo (OR 12.50; 95% CI 2.47–63.14). EN therapies exhibited favorable safety profiles with serious adverse event rates of 0%–3.1% compared with 15.1% for CS and 11.8% for AZA/6-MP. Conclusions EEN and CDED + PEN are the most effective treatments for inducing clinical and endoscopic remission in pediatric CD, with superior safety profiles compared to pharmacological therapies. Immunomodulators remain essential for maintenance therapy. These findings support EN as first-line induction therapy in pediatric CD. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261345561 , PROSPERO CRD420261345561.

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