Disease control 'remains paramount' in limiting growth impairment in pediatric Crohn's

ORLANDO, Fla. — Using mid-parental height estimates in estimating growth potential of a child with inflammatory bowel disease is accurate and physicians can monitor ongoing progress via skeletal maturity levels, but in Crohn’s disease, control of the condition best ensures improved growth, according to a presenter here.

“Mid-parental heights appear to be a very robust method of predicting child height. … Relative changes in skeletal maturity need ongoing monitoring,” Thomas D. Walters, MD, of Hospital of Sick Children in Ontario, Canada, said during the Advances in IBD Meeting. “Regardless of that, our data today should serve as a reminder to us all that effective, continuous disease control remains paramount in the management of children with Crohn’s disease and their impaired linear growth.”

Walters explained that defining linear growth impairment remains a challenge because it is difficult to define the patient’s target. This prospective cohort study aimed to examine the utility of mid-parental height and skeletal maturity in the assessment of growth impairment and reviewed pre- and post-diagnosis linear growth patterns in prepubertal children diagnosed with Crohn’s disease during anti-TNF therapy.

The 208 patients (64% male; 70% Crohn’s disease) were Tanner Stage 1 when diagnosed with IBD and maintaining their follow-up via the center. Researchers collected the mid-parental heights, left wrist radiographs, linear growth, medication exposure and disease activity at regular intervals and calculated a height z-score estimate (average height z-score is 0), an actual height z-score and, therefore, a height z-score deficit.

Walters and colleagues found that patients with Crohn’s disease had a mean actual height z-score of –0.54 at diagnosis (P<.05) and those with ulcerative colitis had an actual height z-score of -0.13, giving them mean height z-score deficits of –0.52 (P<.05) and –0.16, respectively.

In the patients with Crohn’s disease, the researchers looked at the change in mean height z-score at 2 years follow-up. In those with none to minimal disease activity at follow-up, they saw a mean change of 0.15 (P=.04), while those with greater than minimal disease activity saw a change of –.06.

“Most of the well-controlled group experienced an improvement in this after 24 months of therapy. There was no such change seen in the group with greater than minimal disease,” Walters said.

The impact of anti-TNF therapy during the first year was then examined. At baseline, the mean height z-score deficit of those receiving anti-TNF within the first year was –0.88 while those who did not receive anti-TNF in the first year had a deficit of –0.43, something Walters said was in line with physician practice. At 1 year, the mean change in height z-score was 0.16 in receivers and 0.01 in non-receivers. At 2 years, those changes were 0.30 and 0.03, respectively (P=.007).

“In well-controlled patients, even after controlling for baseline differences in height differences, there remained a significant difference in the height deficit improvement in those who were exposed to the anti-TNF therapy. Importantly, in patients who experience ongoing disease activity, anti-TNF exposure had no differential impact on the deficit,” Walters said.

For more information:

Walters T. O-009. Presented at: 2014 Advances in Inflammatory Bowel Diseases, Dec. 4-6, 2014; Orlando, Fla.

Disclosures: Financial disclosures could not be confirmed at this time.