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Disease Status and Pubertal Stage Predict Improved Growth in Anti-TNF Therapy for Pediatric Inflammatory Bowel Disease.

Disease Status and Pubertal Stage Predict Improved Growth in Anti-TNF Therapy for Pediatric Inflammatory Bowel Disease.
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Cameron FL, Altowati MA, Rogers P, McGrogan P, Anderson N, Bisset WM, Ahmed SF, Wilson DC, Russell RK,


Cameron FL, Altowati MA, Rogers P, McGrogan P, Anderson N, Bisset WM, Ahmed SF, Wilson DC, Russell RK, (click to view)

Cameron FL, Altowati MA, Rogers P, McGrogan P, Anderson N, Bisset WM, Ahmed SF, Wilson DC, Russell RK,

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Journal of pediatric gastroenterology and nutrition 2016 9 21()
Abstract
BACKGROUND
Growth failure is well-recognised in pediatric Inflammatory Bowel Disease (PIBD; <18 years). We aimed to examine whether anti-Tumor Necrosis Factor (TNF) therapy improves growth in a PIBD population-based cohort. METHODS
A retrospective review of all Scottish children receiving anti-TNF (infliximab (IFX) and adalimumab (ADA)) from 2000-2012 was performed; height was collected at: 12 months before anti-TNF (T-12), start (T0) and 12 (T+12) months after anti-TNF.

RESULTS
93/201 treated with IFX and 28/49 for 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 ht SDS -0.3 (-0.7,0.2) at T0 changed to 0.04 (-0.5, 0.7) at T+12 (p < 0.001) vs -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. CONCLUSIONS
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 Paediatric Crohn’s disease.

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