Early Infliximab Yields Superior Long-Term Effects on Linear Growth in Pediatric Crohn's Disease Patients

Overview

Journal Gut Liver

Specialty Gastroenterology

Date 2018 Jan 5

PMID 29298460

Citations 10

Authors

Jaeyoung Choi

Ben Kang

Min-Ji Kim

Insuk Sohn

Hae Jeong Lee

Yon Ho Choe

Affiliations

Soon will be listed here.

Abstract

Background/aims: Information regarding the efficacy of early infliximab treatment in pediatric patients with Crohn's disease (CD) is limited. We aimed to evaluate the impact of early combined immunosuppression on linear growth in pediatric patients with CD by performing step-up comparisons.

Methods: This retrospective study included pediatric patients with moderate-to-severe CD, who received a combination therapy with infliximab and azathioprine for at least 3 years and sustained corticosteroid-free remission without loss of response. The z-scores of the growth indicators obtained at the time of diagnosis and annually for 3 years thereafter were compared between the two groups.

Results: The early combined immunosuppression group displayed significantly increased linear growth 3 years after diagnosis (p=0.026). A significant difference was also observed in the linear growth 3 years after diagnosis between subgroups of Tanner stages 1-2 (p=0.016).

Conclusions: The early introduction of biologics should be considered to improve linear growth in pediatric patients with CD.

Citing Articles

Efficacy of Combined Initial Treatment of Methotrexate with Infliximab in Pediatric Crohn's Disease: A Pilot Study.

Kim Y, Kang B, Kim E, Kwon Y, Choe Y, Kim M Biomedicines. 2023; 11(9).

PMID: 37761016 PMC: 10526834. DOI: 10.3390/biomedicines11092575.

Factors Associated with Reaching Mid-Parental Height in Patients Diagnosed with Inflammatory Bowel Disease in Childhood and Adolescent Period.

Choi S, Choi S, Choe B, Park J, Choi K, Lee H Gut Liver. 2023; 18(1):106-115.

PMID: 37638380 PMC: 10791497. DOI: 10.5009/gnl220421.

Infliximab adalimumab: Points to consider when selecting anti-tumor necrosis factor agents in pediatric patients with Crohn's disease.

Kim E, Kang B World J Gastroenterol. 2023; 29(18):2784-2797.

PMID: 37274072 PMC: 10237103. DOI: 10.3748/wjg.v29.i18.2784.

Positioning Biologic Therapies in the Management of Pediatric Inflammatory Bowel Disease.

Breton J, Kastl A, Conrad M, Baldassano R Gastroenterol Hepatol (N Y). 2021; 16(8):400-414.

PMID: 34035746 PMC: 8132662.

Factors Associated with the Immunogenicity of Anti-Tumor Necrosis Factor Agents in Pediatric Patients with Inflammatory Bowel Disease.

Kim J, Lee Y, Choe B, Kang B Gut Liver. 2020; 15(4):588-598.

PMID: 33024062 PMC: 8283299. DOI: 10.5009/gnl20134.

References

Ballinger A . Fundamental mechanisms of growth failure in inflammatory bowel disease. Horm Res. 2002; 58 Suppl 1:7-10. DOI: 10.1159/000064756. View

Mamula P, Telega G, Markowitz J, Brown K, Russo P, Piccoli D . Inflammatory bowel disease in children 5 years of age and younger. Am J Gastroenterol. 2002; 97(8):2005-10. DOI: 10.1111/j.1572-0241.2002.05915.x. View

Khanna R, Bressler B, Levesque B, Zou G, Stitt L, Greenberg G . Early combined immunosuppression for the management of Crohn's disease (REACT): a cluster randomised controlled trial. Lancet. 2015; 386(10006):1825-34. DOI: 10.1016/S0140-6736(15)00068-9. View

Kang B, Choi S, Kim H, Kim K, Lee Y, Choe Y . Mucosal Healing in Paediatric Patients with Moderate-to-Severe Luminal Crohn's Disease Under Combined Immunosuppression: Escalation versus Early Treatment. J Crohns Colitis. 2016; 10(11):1279-1286. DOI: 10.1093/ecco-jcc/jjw086. View

Hyams J, Markowitz J, Otley A, Rosh J, Mack D, Bousvaros A . Evaluation of the pediatric crohn disease activity index: a prospective multicenter experience. J Pediatr Gastroenterol Nutr. 2005; 41(4):416-21. DOI: 10.1097/01.mpg.0000183350.46795.42. View

Caprilli R, Gassull M, Escher J, Moser G, Munkholm P, Forbes A . European evidence based consensus on the diagnosis and management of Crohn's disease: special situations. Gut. 2006; 55 Suppl 1:i36-58. PMC: 1859996. DOI: 10.1136/gut.2005.081950c. View

DHaens G, Baert F, Van Assche G, Caenepeel P, Vergauwe P, Tuynman H . Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: an open randomised trial. Lancet. 2008; 371(9613):660-667. DOI: 10.1016/S0140-6736(08)60304-9. View

Ungar B, Chowers Y, Yavzori M, Picard O, Fudim E, Har-Noy O . The temporal evolution of antidrug antibodies in patients with inflammatory bowel disease treated with infliximab. Gut. 2013; 63(8):1258-64. DOI: 10.1136/gutjnl-2013-305259. View

Hyams J, Walters T, Crandall W, Kugathasan S, Griffiths A, Blank M . Safety and efficacy of maintenance infliximab therapy for moderate-to-severe Crohn's disease in children: REACH open-label extension. Curr Med Res Opin. 2011; 27(3):651-62. DOI: 10.1185/03007995.2010.547575. View

10.

Griffiths A, Nguyen P, Smith C, MacMillan J, Sherman P . Growth and clinical course of children with Crohn's disease. Gut. 1993; 34(7):939-43. PMC: 1374230. DOI: 10.1136/gut.34.7.939. View

11.

Ballinger A, Azooz O, Poole S, Farthing M . Growth failure occurs through a decrease in insulin-like growth factor 1 which is independent of undernutrition in a rat model of colitis. Gut. 2000; 46(5):694-700. PMC: 1727919. DOI: 10.1136/gut.46.5.695. View

12.

Hyams J, Griffiths A, Markowitz J, Baldassano R, Faubion Jr W, Colletti R . Safety and efficacy of adalimumab for moderate to severe Crohn's disease in children. Gastroenterology. 2012; 143(2):365-74.e2. DOI: 10.1053/j.gastro.2012.04.046. View

13.

Borrelli O, Bascietto C, Viola F, Bueno de Mesquita M, Barbato M, Mancini V . Infliximab heals intestinal inflammatory lesions and restores growth in children with Crohn's disease. Dig Liver Dis. 2004; 36(5):342-7. DOI: 10.1016/j.dld.2003.12.014. View

14.

Lee Y, Kang B, Lee Y, Kim M, Choe Y . Infliximab "Top-Down" Strategy is Superior to "Step-Up" in Maintaining Long-Term Remission in the Treatment of Pediatric Crohn Disease. J Pediatr Gastroenterol Nutr. 2015; 60(6):737-43. DOI: 10.1097/MPG.0000000000000711. View

15.

Chun J, Kang B, Lee Y, Lee S, Kim M, Choe Y . Adverse events associated with azathioprine treatment in korean pediatric inflammatory bowel disease patients. Pediatr Gastroenterol Hepatol Nutr. 2013; 16(3):171-7. PMC: 3819691. DOI: 10.5223/pghn.2013.16.3.171. View

16.

Cozijnsen M, Escher J, Griffiths A, Turner D, de Ridder L . Benefits and risks of combining anti-tumor necrosis factor with immunomodulator therapy in pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2015; 21(4):951-61. DOI: 10.1097/MIB.0000000000000245. View

17.

Hyams J, Crandall W, Kugathasan S, Griffiths A, Olson A, Johanns J . Induction and maintenance infliximab therapy for the treatment of moderate-to-severe Crohn's disease in children. Gastroenterology. 2007; 132(3):863-73. DOI: 10.1053/j.gastro.2006.12.003. View

18.

Levine A, Koletzko S, Turner D, Escher J, Cucchiara S, de Ridder L . ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr. 2013; 58(6):795-806. DOI: 10.1097/MPG.0000000000000239. View

19.

Kirschner B, Klich J, Kalman S, DeFavaro M, Rosenberg I . Reversal of growth retardation in Crohn's disease with therapy emphasizing oral nutritional restitution. Gastroenterology. 1981; 80(1):10-5. View

20.

Cameron F, Altowati M, Rogers P, McGrogan P, Anderson N, Bisset W . Disease Status and Pubertal Stage Predict Improved Growth in Antitumor Necrosis Factor Therapy for Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr. 2016; 64(1):47-55. DOI: 10.1097/MPG.0000000000001379. View