title: Disease Status and Pubertal Stage Predict Improved Growth in Antitumor Necrosis Factor Therapy for Pediatric Inflammatory Bowel Disease.
abstract: Growth failure is well-recognized in pediatric inflammatory bowel disease (PIBD; <18 years). We aimed to examine whether antitumor necrosis factor (TNF) therapy improves growth in a PIBD population-based cohort.
  
  
  
  A retrospective review of all Scottish children receiving anti-TNF (infliximab [IFX] and adalimumab [ADA]) from 2000 to 2012 was performed; height was collected at 12 months before anti-TNF (T-12), start (T0), and 12 (T+12) months after anti-TNF.
  
  
  
  Ninety-three of 201 treated with IFX and 28 of 49 with ADA had satisfactory growth data; 66 had full pubertal data. Univariate analysis demonstrated early pubertal stages (Tanner 1-3 n = 44 vs T4-5 n = 22), disease remission, disease duration ≥2 years, and duration of IFX ≥12 months were associated with improved linear growth for IFX; for ADA only improvement was seen in Tanner 1-3. For IFX, Tanner 1-3 median Δ standard deviation scores for height (Ht SDS) -0.3 (-0.7, 0.2) at T0 changed to 0.04 (-0.5, 0.7) at T+12 (P < 0.001) versus -0.01 (-0.5, 0.9) at T0 in T4-5 changed to -0.01 (-0.4, 0.2) at T+12 (P > 0.05). For IFX disease duration ≥2 year, median Δ Ht SDS was -0.13 (-0.6, 0.3) at T0 then 0.07 (-0.3, 0.6) at T+12 (P < 0.001). Remission improved Δ Ht SDS (median Δ Ht SDS -0.14 [-0.6, 0.3] at T0 to 0.17 [-0.2, 0.7] at T+12 [P < 0.001]). Multiple regression analysis demonstrated corticosteroid usage at T0 predicted improved Δ Ht SDS at T+12 for IFX and ADA.
  
  
  
  Anti-TNF therapy is more likely to be associated with growth improvement when used at earlier stages of puberty with remission a key growth-promoting strategy in pediatric Crohn disease.
authors.affiliation: *Child Life and Health, University of Edinburgh, Edinburgh †Developmental Endocrinology Research Group, Royal Hospital for Sick Children, University of Glasgow, Glasgow ‡Department of Pediatric Gastroenterology, Royal Hospital for Sick Children, Edinburgh §Department of Pediatric Gastroenterology, Hospital for Sick Children, Glasgow ||Usher Institute for Population Health Sciences & Informatics, University of Edinburgh, Edinburgh ¶Department of Pediatric Gastroenterology, Royal Aberdeen Children's Hospital, Aberdeen, UK.
authors.forename: Fiona L
authors.initials: FL
authors.lastname: Cameron
authors.forename: Mabrouka A
authors.initials: MA
authors.lastname: Altowati
authors.forename: Pamela
authors.initials: P
authors.lastname: Rogers
authors.forename: Paraic
authors.initials: P
authors.lastname: McGrogan
authors.forename: Niall
authors.initials: N
authors.lastname: Anderson
authors.forename: William Michael
authors.initials: WM
authors.lastname: Bisset
authors.forename: Syed Faisal
authors.initials: SF
authors.lastname: Ahmed
authors.forename: David C
authors.initials: DC
authors.lastname: Wilson
authors.forename: Richard K
authors.initials: RK
authors.lastname: Russell
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001827:Body Height; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006130:Growth Disorders / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007167:Immunotherapy; D015212:Inflammatory Bowel Diseases; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D011627:Puberty; D012189:Retrospective Studies; D012606:Scotland; D012720:Severity of Illness Index; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab