ESPE Abstracts (2014) 82 P-D-1-3-162

Infliximab Improves Growth in Paediatric Crohn[apos]s disease Only if Commenced Early in Puberty or Prior to the Onset of Puberty

Arundoss Gangadharana, Joanna Metcalfb, Dinesh Giria, Sharon Irvingc, Marcus Authc, Krishnappa Venkateshc, Balaji Krishnamurthyc, Joanne C Blaira & Mohammed Didia

aDepartment of Paediatric Endocrinology, Alder Hey Children’s Hospital, Liverpool, UK; bLiverpool Medical University, Liverpool, UK; cDepartment of Paediatric Gastroenterology, Alder Hey Children’s Hospital, Liverpool, UK

Background: Crohn’s disease is a relapsing systemic inflammatory disorder with inflammatory bowel disease (IBD) due to up-regulation of pro-inflammatory cytokines including TNFα. More than 80% of newly diagnosed children present with growth failure Paediatric gastroenterology units in the UK submit data to the UK IBD database which can be accessed when required. One aim of current treatment protocols is to promote growth. Studies on the use of anti-TNFα antibodies like Infliximab have produced conflicting results with respect to growth.

Objective: To determine whether Infliximab improves growth in paediatric Crohn’s disease.

Method: The UK IBD database was used to identify all Crohn’s disease patients at Alder Hey Hospital, Liverpool, UK receiving Infliximab. Age, height, weight, and Tanner pubertal status were determined at commencement of Infliximab, 9–12 months later or at the latest assessment. The height and weight SDS were calculated. Paired t-test was employed to compare height and weight SDS at these time points for patients who were at Tanner stages 1–3 vs those at stages 4–5 at commencement of Infliximab therapy.

Results: There were 31 patients (14 females). The median age at commencement of Infliximab treatment was 14.3 years (range 7.5–17.4 years). The median duration of follow-up since commencement of Infliximab therapy was 1.6 years (0.3–2.0). Twenty patients at Tanner stages 1–3 had median height SDS −0.45 (−1.88 to +1.86), at the second assessment which was significantly better than at commencement of infliximab (median −0.94 (−2.15 to +1.72)), (P=0.018).

Conclusion: Infliximab improves growth in children with Crohn’s disease who are in early stages of puberty. Pubertal hormones appear to modulate the TNFα availability for attack by a TNFα antibody.