PWE-072 The Effects Of Anti-tnf Therapy On Growth In Ibd In Scottish Children

Abstract

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 DELTA 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), DELTA 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). DELTA 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 DELTA 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 DELTA height SDS or height velocity was observed at T-12, T 0 or T +12 (p > 0.05). Conclusions: 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.