title: Long-term outcome of tumor necrosis factor alpha antagonist's treatment in pediatric Crohn's disease.
abstract: BACKGROUND
  Anti tumor necrosis factor alpha (TNFα) agents have become widely used in pediatric inflammatory bowel disease (IBD). So far, only few studies examined the long-term results of anti-TNFα treatment in children with IBD.
  
  
  METHODS
  The long-term outcome of pediatric patients with IBD was assessed retrospectively in a multicenter cohort of children treated with anti-TNFα beyond induction treatment. Short- and long-term response rates, predictors for loss of response, data on growth and laboratory parameters were assessed.
  
  
  RESULTS
  120 patients [101 crohn's disease (CD), 19 ulcerative colitis (UC) or indeterminate colitis (IC)] received either infliximab or adalimumab. The mean age at initiation of anti-TNFα was 13.4 ± 3.9 years and the median duration of anti-TNFα treatment was 15 months (range: 2-90). Overall, 89% of the cohort experienced short-term response following induction. Response was associated with improvement in weight and BMI Z-scores (p<0.001) but not with linear growth. Responders experienced a significant decrease in erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) during treatment (p<0.001). Albumin and hemoglobin both improved but only albumin increased significantly (p<0.001). The cumulative probability of losing response to anti-TNFα treatment was 17%, 38%, and 49% after 1, 3, and 5 years, respectively. Responders had a significantly lower weight and BMI Z-scores at initiation of anti-TNFα treatment in compared to non-responders (p=0.04 and 0.02 respectively).
  
  
  CONCLUSIONS
  Our long term cohort supports the current evidence on the effectiveness and safety of anti-TNFα treatment in children with IBD. Response to treatment was interestingly associated with lower weight and BMI.
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petach-Tikva, Israel. dr.amit.assa@gmail.com
authors.forename: Amit
authors.initials: A
authors.lastname: Assa
authors.forename: Corina
authors.initials: C
authors.lastname: Hartman
authors.forename: Batia
authors.initials: B
authors.lastname: Weiss
authors.forename: Efrat
authors.initials: E
authors.lastname: Broide
authors.forename: Yoram
authors.initials: Y
authors.lastname: Rosenbach
authors.forename: Noam
authors.initials: N
authors.lastname: Zevit
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bujanover
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001799:Blood Sedimentation; D015992:Body Mass Index; D001835:Body Weight; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D060828:Induction Chemotherapy; D007223:Infant; D000069285:Infliximab; D008297:Male; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D006454:Hemoglobins; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000069285:Infliximab; D000068879:Adalimumab