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P322. The effects of anti TNF therapy on growth in Scottish children with IBD

F.L. Cameron1, M. Al Towati2, P. Rogers3, P. McGrogan4, W.M. Bisset5, S.F. Ahmed2, D.C. Wilson1, R.K. Russell4, 1University of Edinburgh, Child Life and Health, Edinburgh, United Kingdom, 2University of Glasgow, Child Health, Glasgow, United Kingdom, 3Royal Hospital for Sick Children, Paediatric Gastroenterology, Edinburgh, United Kingdom, 4Royal Hospital for Sick Children, Paediatric Gastroenterology, Glasgow, United Kingdom, 5Royal Aberdeen Children's Hospital, Department of Paediatric Gastroenterology, Aberdeen, United Kingdom

Background

Growth failure is well-recognised in paediatric IBD (PIBD; <18 years). Evidence (usually case series from single or multiple centres) shows that anti-TNF therapies improve linear growth. We aimed to examine if anti-TNF therapy improves growth in a PIBD population-based cohort.

Methods

A retrospective review was performed in all Scottish PIBD centres of children receiving anti-TNF [Infliximab (IFX) and Adalimumab (ADA)] from 2000–2012. Height, weight and Tanner stage were collected at 3 times: 12 months before anti-TNF (T −12), start of anti-TNF (T 0) and 12 months after anti-TNF (T +12). Height values were converted into standard deviation scores and height velocity was calculated in cm/year.

Results

Full 12 month growth data was available for 98 PIBD cases (4ADA, 94 IFX), 58 (59%) males and 90 (92%) Crohn's disease (CD); 84 (86%) received immunomodulators and 55 (56%) corticosteroids at T 0. Median age at diagnosis was 10.3 years. Mean height SDS T −12 was −0.67±1.1, a significant improvement was then seen from T 0 −0.82±1.1 to T +12 −.074±1.1 (p = 0.019). Mean Δ height SDS improved from −0.16±0.38 at T 0 to 0.08±0.35 at T +12 (p < 0.001) with height velocity improving from 3.9±2.5 at T 0 to 5.0±2.9 (p = 0.003).

52 (53%) were Tanner 1–4; 47 CD, 49 IFX/3 ADA. Mean height SDS improved slightly from T 0 −1.2(±1.1) to −1.1(±1.1) at T +12 (p = 0.31), Δ height SDS at T 0 −0.23(±0.33) improved to 0.06(±0.40) at T +12 (p < 0.001) and height velocity 3.8(±2.3) at T 0 improved to 5.4(±2.6) at T +12 (p = 0.001). 27 (52%) entered remission with the significant prior decrease in height SDS from T −12 to T 0, T −12 −0.92(±1.2) to T 0 −1.1(±1.3), subsequently improving to −0.9(±1.2) at T +12 (p = 0.005). Δ height SDS improved from T 0 −0.21(±0.32) to 0.23(±0.34) at T +12 (p < 0.001) and height velocity from 3.9(±2.3) at T 0 to 6.3(±1.9) at T +12 (p = 0.001). In those who did not achieve remission (n = 25, 48%), no improvement was then seen in height SDS T 0 to T +12, mean Δ height SDS or height velocity (p > 0.05).

In ulcerative colitis (UC), no difference in height SDS was seen; for remission (n = 5), T −12 0.17±0.67 to 0.16 at T 0 then 0.12±0.85 at T +12 (p > 0.05) whilst for non-remission (n = 3) decreased height SDS at T −12 0.03±1.96, then −0.27 at T 0 and −0.44 at T +12 (p > 0.05) was seen. No change was seen in Δ height SDS or height velocity was observed at T-12, T 0 or T +12 (p > 0.05).

Conclusion

Improvements in height SDS and height velocity at 12 months were seen in those with remission. No improvement in height was seen for UC irrespective of remission; numbers in both groups were small. Further follow up is needed to determine if growth improvement is maintained in those achieving remission.