title: Improvement in growth of children with Crohn disease following anti-TNF-α therapy can be independent of pubertal progress and glucocorticoid reduction.
abstract: OBJECTIVE
  Treatment with antitumour necrosis factor-α therapy such as infliximab may improve growth in children with Crohn disease (CD), but the extent of improvement in growth and its relation to pubertal progress and glucocorticoid (GC) therapy are unclear. This is a retrospective study of growth, puberty, and disease activity during the 6 months before starting infliximab (T - 6), at baseline (T0), and for the following 6 months (T + 6) and 12 months (T + 12) in children with CD.
  
  
  METHODS
  The growth and treatment details of 28 children (male, 17) who were given infliximab at a median (10th, 90th) age of 13.1 years (10.0, 15.7) were reviewed. Data on disease markers (C-reactive protein, erythrocyte sedimentation rate, and albumin), total alkaline phosphatase, and a physician's global assessment were also collected. Results are expressed as median (10th, 90th).
  
  
  RESULTS
  Of the 28 cases, 21 (75%) demonstrated a clinical response to infliximab treatment. Overall, height velocity (HV) increased from 3.6 cm/y (0.4-7.8) at T0 to 5.5 cm/y (2.1-9.2) at T + 6 (P = 0.003). In infliximab responders, HV increased from 2 cm/y (0.3-7.1) to 6.4 cm/y (2.3-9.1) (P = 0.004) and in the nonresponders, HV remained static at 4.3 cm/y (2.5-8.6) at T0 and 3.0 cm/y (2.0-11.3) (P = 0.701) at T + 6. HV also increased in the subgroup of 13 children who had remained prepubertal from 4.5 cm/y (0.4-8) to 5.5 cm/y (3.3-8.4) (P = 0.050). In the subgroup of 11 children who had a reduction (n = 2) or cessation in GC (n = 9), HV increased from 1.8 cm/y (0.3-8.3) at T0 to 5.6 cm/y (2.2-9.2) at T + 6 (P = 0.14), whereas those children who did not receive GC during the 12 months had an increase from 3.7 cm/y (0.6-6.5) to 6.4 cm/y (2.9-9.0) (P < 0.05). HV at T0 and T + 6 showed a significant association with the average alkaline phosphatase during the prior 6 months (r = 0.39, P < 0.05). HV did not show any association with individual markers of disease activity.
  
  
  CONCLUSIONS
  Clinical response to infliximab therapy is associated with an improvement in linear growth in the short term in children with CD. This increase in height may not be simply due to progress in pubertal status or reduction in GC dose.
authors.affiliation: Bone and Endocrine Research Group, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
authors.forename: S
authors.initials: S
authors.lastname: Malik
authors.forename: S C
authors.initials: SC
authors.lastname: Wong
authors.forename: J
authors.initials: J
authors.lastname: Bishop
authors.forename: K
authors.initials: K
authors.lastname: Hassan
authors.forename: P
authors.initials: P
authors.lastname: McGrogan
authors.forename: S F
authors.initials: SF
authors.lastname: Ahmed
authors.forename: R K
authors.initials: RK
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001827:Body Height / Q000187:drug effects; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy* / Q000503:physiopathology*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006128:Growth / Q000187:drug effects*; D006801:Humans; D000069285:Infliximab; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D015999:Multivariate Analysis; D011627:Puberty / Q000502:physiology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D005938:Glucocorticoids; D000069285:Infliximab; D008727:Methotrexate