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Disease Status and Pubertal Stage Predict Improved Growth in Antitumor Necrosis Factor Therapy for Pediatric
Fiona L Cameron1, Mabrouka A Altowati, Pamela Rogers
1*Child Life and Health, University of Edinburgh, Edinburgh †Developmental Endocrinology Research Group, Royal Hospital for Sick Children, University of Glasgow, Glasgow ‡Department of Pediatric Gastroenterology, Royal Hospital for Sick Children, Edinburgh §Department of Pediatric Gastroenterology, Hospital for Sick Children, Glasgow ||Usher Institute for Population Health Sciences & Informatics, University of Edinburgh, Edinburgh ¶Department of Pediatric Gastroenterology, Royal Aberdeen Children's Hospital, Aberdeen, UK.
Insights
Antitumor necrosis factor (TNF) therapy can improve growth in children with inflammatory bowel disease, particularly when initiated early in puberty. Achieving disease remission is crucial for promoting growth in pediatric Crohn disease patients.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Biologic Therapies
Background:
- Growth failure is a significant concern in pediatric inflammatory bowel disease (PIBD).
- Antitumor necrosis factor (TNF) therapies are used to manage PIBD.
- The impact of anti-TNF therapy on growth in PIBD requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of anti-TNF therapy in improving linear growth in a population-based cohort of PIBD patients.
- To identify factors associated with improved growth outcomes during anti-TNF treatment.
Main Methods:
- Retrospective review of Scottish children (<18 years) treated with infliximab (IFX) or adalimumab (ADA) from 2000-2012.
- Height standard deviation scores (SDS) were collected at 12 months before (T-12), start (T0), and 12 months after (T+12) anti-TNF initiation.
- Univariate and multiple regression analyses were used to assess growth predictors.
Main Results:
- Anti-TNF therapy, particularly IFX, was associated with significant height SDS improvement in patients in early puberty (Tanner stages 1-3).
- Disease remission and longer disease duration (≥2 years) were linked to better growth outcomes with IFX.
- Corticosteroid use at treatment initiation predicted improved height SDS at 12 months for both IFX and ADA.
Conclusions:
- Anti-TNF therapy shows potential for growth enhancement in PIBD patients.
- Early initiation of anti-TNF therapy during earlier pubertal stages is associated with greater growth improvement.
- Maintaining disease remission is a key strategy for promoting growth in pediatric Crohn disease.
Background:
Growth failure is well-recognized in pediatric inflammatory bowel disease (PIBD; <18 years). We aimed to examine whether antitumor 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 to 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:
Ninety-three of 201 treated with IFX and 28 of 49 with 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 Δ standard deviation scores for height (Ht SDS) -0.3 (-0.7, 0.2) at T0 changed to 0.04 (-0.5, 0.7) at T+12 (P < 0.001) versus -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 Δ 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 Δ Ht SDS (median Δ 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 Δ 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 pediatric Crohn disease.
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