ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 17 P8

Lack of short-term catch up growth in children with Crohn's disease treated with infliximab

SC Wong1, S Malik1, RK Russell2, P McGrogan2 & SF Ahmed1

1Bone and Endocrine Research Group, Royal Hospital for Sick Children, Glasgow, UK; 2Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Sick Children, Glasgow, UK.

Background: Recent studies show that infliximab (IFX), an antibody against tumour necrosis factorα (TNFα), may improve growth in children with Crohn’s disease (CD). These studies have not adequately addressed the concomitant factors such as medication, nutrition and puberty that may also improve growth.

Methods: Retrospective study of 22 children (13M) with CD, median age at start of IFX 13.2 years (7.4, 16.1) with auxology at 6 months before (T−6) and 6 months after (T+6) starting IFX. Puberty was available for 15 of the children at T−6, T+0 and T+6. Height velocity (HV) was converted into SDS and adjusted for delayed puberty for children ≥12 years.

Results: Median HtSDS at diagnosis, −0.4 (range, −1.9, 2.8) was similar to target height (TH) SDS, 0.1 (−1.4, 1.5) but median HtSDS at T−6: −0.8 (−2.0, 1.6), T+0: −0.7 (−2.3, 1.9) and T+6: −0.9 (−2.3, 2.4) were lower than THSDS (P<0.05). Median HtSDS at T+0 and T+6 was similar (P=0.77). Median HV T+0 and T+6 was 3.2 cm/year (0.0, 10.2.) and 6.4 cm/year (0.0, 9.4), respectively (P=0.17). Four groups of children could be identified based on change (Δ) in HtSDS before and after IFX. Five out of 22 (22.7%) had no growth issues (ΔHtSDS≥0 before and after IFX); three out of 22 (13.6%) had faltering growth (ΔHtSDS≥0 before and <0 after IFX); six out of 22 (27.3%)had continual deterioration (ΔHtSDS<0 before and after IFX)and eight out of 22 (36.4%)had catch up growth (ΔHtSDS<0 before and ≥0 after IFX).

P value
T−6 (n, 15)T+0 (n, 15)T+6 (n, 15)(T+6 vs T+0)
Age (years)12.4 (7.4, 16.1) 13.0 (8.0, 16.8) 13.7 (8.6, 17.2)
Tanner stage 1, 2, 3, 411, 2.2.09, 3, 3, 08, 4, 2, 1
HV (cm/year)4.7 (0.0, 10.2)6.1 (0.0, 9.4)0.65
HVSDS−1.4 (−6.9, 5.2)0.0 (−7.3, 4.9)0.95
ESR (mm)a31.0 (4.0, 62.0)29.0 (6.0, 63.0)0.39
CRP (mg/l)a15.0 (7.0, 42.0)9.0 (7.0, 21.0)0.39
Albumin (g/l)a34.0 (23.0, 43.0)39.0 (29.0, 50.0)0.62
Plateletsa374 (180, 631)368 (215.0, 483.0)0.89
Prednisolone (mg/kg per day)0.0 (0.0, 6.6)0.0 (0.0, 0.3)0.44
Azathioprine use672
Methotrexate use5713
aAverage 6 months.

Conclusion: Introduction of infliximab did not lead to a universal improvement in linear growth and puberty in children with Crohn’s disease. The lack of improvement in linear growth may be explained by direct, irreversible effects of multiple proinflammatory cytokines on the growth plate in sub groups of children. Further, adequately powered prospective clinical studies are required to study catch-up growth in these children.

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