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Long-term outcome of tumor necrosis factor alpha antagonist's treatment in pediatric Crohn's disease
Amit Assa1, Corina Hartman, Batia Weiss
1Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petach-Tikva, Israel. dr.amit.assa@gmail.com
Insights
Anti tumor necrosis factor alpha (TNFα) therapy is effective for pediatric inflammatory bowel disease (IBD). Lower weight and BMI at treatment initiation predict better response in children with IBD.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Inflammatory Bowel Disease Research
Background:
- Anti-tumor necrosis factor alpha (TNFα) agents are increasingly utilized for pediatric inflammatory bowel disease (IBD).
- Limited studies have evaluated the long-term efficacy and outcomes of anti-TNFα treatment in pediatric IBD patients.
Purpose of the Study:
- To assess the long-term outcomes of anti-TNFα treatment in a multicenter cohort of pediatric IBD patients.
- To identify predictors of response and loss of response to anti-TNFα therapy.
- To evaluate the impact of anti-TNFα treatment on growth and laboratory parameters in children with IBD.
Main Methods:
- Retrospective analysis of a multicenter cohort of pediatric patients with IBD treated with anti-TNFα agents (infliximab or adalimumab).
- Assessment of short- and long-term response rates, predictors for loss of response, growth parameters (weight, BMI, linear growth), and laboratory markers (ESR, CRP, albumin, hemoglobin).
Main Results:
- 89% of patients achieved short-term response. Response was linked to improvements in weight and BMI Z-scores, but not linear growth.
- Significant reductions in ESR and CRP were observed in responders. Albumin levels increased significantly.
- Cumulative probabilities of losing response were 17% (1 year), 38% (3 years), and 49% (5 years).
- Lower weight and BMI Z-scores at anti-TNFα initiation were associated with a higher likelihood of response.
Conclusions:
- Long-term data support the effectiveness and safety of anti-TNFα treatment in pediatric IBD.
- Patient weight and BMI at the start of anti-TNFα therapy are associated with treatment response in children with IBD.
Background:
Anti tumor necrosis factor alpha (TNFα) agents have become widely used in pediatric inflammatory bowel disease (IBD). So far, only few studies examined the long-term results of anti-TNFα treatment in children with IBD.
Methods:
The long-term outcome of pediatric patients with IBD was assessed retrospectively in a multicenter cohort of children treated with anti-TNFα beyond induction treatment. Short- and long-term response rates, predictors for loss of response, data on growth and laboratory parameters were assessed.
Results:
120 patients [101 crohn's disease (CD), 19 ulcerative colitis (UC) or indeterminate colitis (IC)] received either infliximab or adalimumab. The mean age at initiation of anti-TNFα was 13.4 ± 3.9 years and the median duration of anti-TNFα treatment was 15 months (range: 2-90). Overall, 89% of the cohort experienced short-term response following induction. Response was associated with improvement in weight and BMI Z-scores (p<0.001) but not with linear growth. Responders experienced a significant decrease in erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) during treatment (p<0.001). Albumin and hemoglobin both improved but only albumin increased significantly (p<0.001). The cumulative probability of losing response to anti-TNFα treatment was 17%, 38%, and 49% after 1, 3, and 5 years, respectively. Responders had a significantly lower weight and BMI Z-scores at initiation of anti-TNFα treatment in compared to non-responders (p=0.04 and 0.02 respectively).
Conclusions:
Our long term cohort supports the current evidence on the effectiveness and safety of anti-TNFα treatment in children with IBD. Response to treatment was interestingly associated with lower weight and BMI.
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