INITIATION of anti-TNF therapy can lead to significant improvement in growth disturbances among children with Crohn’s disease, according to new research presented at the Crohn’s & Colitis Congress in Las Vegas, Nevada, USA. Natalia Plott, Riley Hospital for Children at Indiana University School of Medicine, Indianapolis, USA, stated that growth failure impacts 15–40% of patients with Crohn’s disease, and up to one in four children with Crohn’s disease will not achieve their full growth potential.
Plott and colleagues analysed data from the multicentre COMBINE trial, which included 199 children with Crohn’s (mean age: 12 years; 25% female), assigned to infliximab or adalimumab in combination with oral methotrexate, or anti-TNF alone. The team collected demographic, clinical, and anthropometric data at enrolment, after 12 months, and after 24 months, and classified weight, height, and BMI Z-scores as either normal (≥–1), or having a disturbance (<–1).
Results showed that 26.6% of children had a weight disturbance at baseline, 27.7% had a height disturbance, and 19.7% had a BMI disturbance. At the time of anti-TNF initiation, gender, race, ethnicity, and age were not different between the groups with and without weight, height, or BMI disturbances. Furthermore, compared with children with normal parameters, those with weight, height, or BMI disturbances at baseline had a higher mean short paediatric Crohn’s disease activity index.
The number of patients with growth disturbances notably decreased 12 and 24 months after initiation of anti-TNF therapy. The proportion of children with a height disturbance at 12 months was 6.1%, which further decreased to 0.9% at 24 months. Similar reductions were reported for BMI (7.5% at 12 months; 2.8% at 24 months) and weight (5.7% at 12 months; 0.8% at 24 months), demonstrating a significant improvement in growth disturbances after the initiation of anti-TNF therapy.
“These biologic therapies will not only provide disease control leading to symptom relief, but a positive, long-term outcome […] as they can facilitate improvements in self-esteem and psychological wellbeing during such a formative stage in a child’s development,” stated Plott. She concluded that these findings support speaking to patients and families about anti-TNF initiation at the time of Crohn’s diagnosis.
