Disease status and pubertal stage predict improved growth in anti-TNF therapy for pediatric inflammatory bowel disease

Cameron, F. L., Altowati, M. A., Rogers, P., McGrogan, P., Anderson, N., Bisset, W. M., Ahmed, S. F. , Wilson, D. C. and Russell, R. K. (2017) Disease status and pubertal stage predict improved growth in anti-TNF therapy for pediatric inflammatory bowel disease. Journal of Pediatric Gastroenterology and Nutrition, 64(1), pp. 47-55. (doi: 10.1097/MPG.0000000000001379) (PMID:27657882)

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Abstract

Background: Growth failure is well-recognised in pediatric Inflammatory Bowel Disease (PIBD; <18 years). We aimed to examine whether anti-Tumor Necrosis Factor (TNF) therapy improves growth in a PIBD population-based cohort. Methods: A retrospective review of all Scottish children receiving anti-TNF (infliximab (IFX) and adalimumab (ADA)) from 2000-2012 was performed; height was collected at: 12 months before anti-TNF (T-12), start (T0) and 12 (T+12) months after anti-TNF. Results: 93/201 treated with IFX and 28/49 for ADA had satisfactory growth data; 66 had full pubertal data. Univariate analysis demonstrated early pubertal stages (Tanner 1-3 n = 44 vs. T4-5 n = 22), disease remission, disease duration >=2 years and duration of IFX >=12 months were associated with improved linear growth for IFX; for ADA only improvement was seen in Tanner 1-3. For IFX, Tanner 1-3 median [DELTA] ht SDS -0.3 (-0.7,0.2) at T0 changed to 0.04 (-0.5, 0.7) at T+12 (p < 0.001) vs -0.01 (-0.5, 0.9) at T0 in T4-5 changed to -0.01 (-0.4, 0.2) at T+12 (p > 0.05). For IFX disease duration >=2 year, median [DELTA] ht SDS was -0.13 (-0.6, 0.3) at T0 then 0.07 (-0.3, 0.6) at T+12 (p < 0.001). Remission improved [DELTA] ht SDS (median [DELTA] ht SDS -0.14 (-0.6, 0.3) at T0 to 0.17 (-0.2, 0.7) at T+12 (p > 0.001)). Multiple regression analysis demonstrated corticosteroid usage at T0 predicted improved [DELTA] ht SDS at T+12 for IFX and ADA. Conclusions: Anti-TNF therapy is more likely to be associated with growth improvement when used at earlier stages of puberty with remission a key growth-promoting strategy in Paediatric Crohn's disease.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Russell, Dr Richard and Ahmed, Professor Syed Faisal
Authors: Cameron, F. L., Altowati, M. A., Rogers, P., McGrogan, P., Anderson, N., Bisset, W. M., Ahmed, S. F., Wilson, D. C., and Russell, R. K.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of Pediatric Gastroenterology and Nutrition
Publisher:Lippincott, Williams & Wilkins
ISSN:0277-2116
ISSN (Online):1536-4801
Published Online:21 September 2016
Copyright Holders:Copyright © 2016 ESPGHAN and NASPGHAN
First Published:First published in Journal of Pediatric Gastroenterology and Nutrition 64(1): 47-55
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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