Linear growth improves during infliximab therapy in children with chronically active severe Crohn's disease

Background: The efficacy of infliximab as maintenance therapy in patients with otherwise chronically active Crohn's disease (CD) is well established. Data concerning the linear growth response are sparse and can only be accrued in children. Methods: From September 2000 to February 2004, 32 children and adolescents (63% males; mean age 13.4 years, range 4.7-17.3) with chronically active CD despite immunomodulatory and prior corticosteroid therapy commenced infliximab therapy. Growth parameters standardized for age, gender, and pubertal development prior to and following infliximab therapy were compared. Results: In all, 28 of 32 patients tolerated and responded to the induction regimen and 27 responders continued to receive infliximab via regularly scheduled infusions (n = 22) or episodically (n = 5) for a median of 26 months. Mean standard deviation score (SDS) for height at time of initiation of infliximab therapy was -1.15 +/- 1.2 and had declined despite the use of other therapies from -0.44 +/- 1.1 at initial diagnosis. Increases in height velocity and stature during infliximab therapy were limited by pubertal stage: Tanner I-III: Delta SDS for height velocity +3.94, for height +0.50, P < 0.001; Tanner IV, V: Delta SDS for height velocity +0.22, for height 0.02, P = NS. Conclusions: Height velocity improves and height centile increases during infliximab therapy provided patients are treated prior to or in early puberty. These data support the use of infliximab in young patients with otherwise refractory disease, and suggest that ultimate height in this subset of children with severe CD may be less compromised than with previous therapies.