The effects of anti-TNF-α treatment with adalimumab on growth in children with Crohn's disease (CD)

Introduction: Adalimumab is used to treat children with Crohn's disease (CD), but the effects of adalimumab on growth in CD have not been studied. Aim: To study growth and disease activity over 12 months (6 months prior to (T-6), baseline (TO) and for 6 months following (T+6) adalimumab). Subjects and methods: Growth and treatment details of 36 children (M: 22) who started adalimumab at a median (10th, 90th) age of 14.7 years (11.3, 16.8) were reviewed. Results: Of 36 cases, 28 (78%) went into remission. Overall 42% of children showed catch up growth, which was more likely in: (i) those who achieved remission (median change in height SDS (Delta HtSDS) increased from -0.2 (-0.9, 1.0) at T0 to 0.2 (-0.6, 1.6) at T+6, (p=0.007)), (ii) in those who were on immunosuppression Delta HtSDS increased from 0.2 (-0.9, 1.0) at TO to 0.1 (-0.8, 1.3) at T+6, (p=0.03) and (iii) in those whose indication for using adalimumab therapy was an allergic reaction to infliximab, median Delta HtSDS increased significantly from -0.3 (-0.9, 1.0) at TO to 0.3 (-0.5, 1.6) at T + 6, (p=0.02). Median Delta HtSDS also increased from -0.4 (-0.8, 0.7) at T0 to 0.0 (-0.6, 1.6) at 1+6, (p=0.04) in 15 children who were on prednisolone therapy when starting adalimumab. Conclusion: Clinical response to adalimumab therapy is associated with an improvement in linear growth in a proportion of children with CD. Improved growth is more likely in patients entering remission and on immunosuppression but is not solely due to a steroid sparing effect. (C) 2011 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.