Anti-TNF therapy significantly improves growth disturbances in pediatric Crohn’s
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Key takeaways:
- At baseline, 26.6% of children with Crohn’s had a weight disturbance, 27.7% had a height disturbance and 19.7% had a BMI disturbance.
- At 12 months, this decreased to 5.7%, 6.1% and 7.5%, respectively.
LAS VEGAS — Although a substantial proportion of children with Crohn’s disease had growth disturbances at initiation of anti-tumor necrosis factor therapy, “significant improvement” was noted up to 24 months after treatment, data showed.
“It has been noted that growth failure impacts 15% to 40% of those with Crohn’s disease, with some studies showing that up to one quarter of children with Crohn’s disease will not achieve their full growth potential,” Natalia Plott, MD, a second-year pediatric gastroenterology fellow at Riley Hospital for Children at Indiana University School of Medicine, said during a presentation at the Crohn’s & Colitis Congress. “This can unfortunately in turn lead to anxieties that affect a child’s quality of life.”
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She continued, “In order to treat the underlying inflammation we as providers can look at medical, nutritional and surgical approaches and how this affects the preexisting growth failure. ... Within the pediatric population, long-term data on growth promotion after the initiation of anti-TNF therapy is limited.”
Plott and colleagues analyzed data from the multicenter COMBINE trial, which included 199 children with CD (mean age, 12 years; 25% girls) assigned to infliximab or adalimumab in combination with oral methotrexate or anti-TNF alone.
At enrollment and after 12 and 24 months of treatment, researchers collected demographic, clinical and anthropometric data and classified weight, height and BMI Z- scores as either normal (≥ –1) or having a disturbance (< –1).
“Overall, when looking at our study population at the time of diagnosis, we found that gender, race, ethnicity and age at the time of anti-TNF initiation were not different between the groups with and without weight, height or BMI disturbances,” Plott said.
According to results, 26.6% children had a weight disturbance at baseline, 27.7% had a height disturbance and 19.7% had a BMI disturbance. Compared with children with normal parameters, those with weight, height or BMI disturbances at baseline had a higher mean short pediatric CD activity index.
“Approximately 12 months after enrollment, the proportion of patients with disturbances notably decreased, with a continued decrease at 24 months,” Plott said.
Results showed the proportion of children with a height disturbance at 12 months was 6.1%, which decreased to 0.9% at 24 months. Similar reductions were reported for BMI (7.5% to 2.8%) and weight (5.7% to 0.8%), demonstrating a “significant improvement in growth disturbances after the initiation of the anti-TNF biologic therapies,” Plott said.
“Overall, these outcomes are very important as they further support counseling and speaking to patients and families about anti-TNF initiation at the time of diagnosis,” she concluded. “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 well-being during such a formative stage in a child's development.”
Plott continued, “Furthermore, for those found to have disturbances at time of diagnosis, this concern is an additional indication for considering anti-TNF biologics as a therapy of choice for treatment of inflammatory bowel disease.”
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Plott N, et al. Improvement in growth and nutrition status after anti-TNF therapy initiation among patients with pediatric Crohn’s disease: Results from the combine trial. Presented at: Crohn’s & Colitis Congress; Jan. 25-27, 2024; Las Vegas.
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