Update on nutritional status, body composition and growth in paediatric inflammatory bowel disease

Table 1 Summary of studies investigating the impact of biologics on linear growth

Ref.	Study type and biologic	Subjects and medication at baseline	Growth failure1	Pubertal status data	Measurement times	Remission achieved	Linear growth outcomes
Afzal et al[19]	Retrospective; infliximab	n = 24; median age: 10.3 yr; All concomitant immunosuppression	No	n = 0 in Tanner 5	T - 6; T0; T + 6 post 3rd infusion	n = 17 clinical remission after 3rd infusion; of these, n = 14 relapsed and required further infusions	No sig Δ ht Z at T + 6
Diamanti et al[20]	Retrospective; infliximab	n = 28; median age: 13 yr in infliximab, 5-ASA and azathioprine (Group A: n = 14); 14 yr in 5-ASA and azathioprine (Group B: n = 14)	Data not given	Data not given	T0; median 10 mo post	Clinical remission in group A	No sig Δ HV Z at 10 mo post for either group
Sinitsky et al[21]	Retrospective; infliximab	n = 16; mean age 13.0 yr; n = 2 concomitant MTX; n = 1 6-MP; n = 1 tacrolimus; n = 8 5-ASA; n = 14 azathioprine; n = 7 corticosteroid	No	Data not given	T0; T + 12	n = 10 clinical remission	No sig Δ ht Z at T + 12
Pfefferkorn et al[22]	Prospective; infliximab	Subgroup n = 34 commencing infliximab during first year of study; mean age: data not given; concomitant medication: data not given	No	Tanner 1-3	Dx; T + 12; T + 24	Data not given	No sig Δ HV Z at T + 12; No sig difference HV Z at T + 24 between infliximab ≥ 1 yr, vs < 1 yr or no infliximab
Borrelli et al[23]	Prospective; infliximab	n = 18; median age: 13 yr; n = 18 concomitant azathioprine; n = 15 mesalamine; n = 13 corticosteroids	Yes in retreated group only	No	T0; T + 6	After induction n = 10 clinical remission; n = 12 inflammatory remission. n = 8 were retreated	Sig ↑ ht Z from T0 to T + 6 in retreated group only; Note: all in retreated group had achieved clinical and inflammatory remission
Cezard et al[24]	Prospective; infliximab	Subgroup n = 10; mean age: data not given; concomitant medication: data not given	No	Pubertal growth not completed	T-12; T + 12	Data not given	Sig ↑ HV Z at T + 12
de Ridder et al[25]	Retrospective; infliximab	Subgroup n = 6 of refractory group; mean age: 13.8 yr; of these, n = 6 concomitant immunosuppression; n = 4 corticosteroids	Yes	No	Collection points unclear: patients followed for 8-122 mo	n = 3 good response; n = 2 became unresponsive at second infusion; n = 1 ceased due to allergy	n = 3 resumed normal linear growth velocity, all of which were in good response group; n = 3 no change
Hyams et al[26]	Prospective;infliximab,randomizedto 8 or 12weeklyinfusions	n = 103; mean age: 13.3 yr; however, ht Z only assessed in those with > 1 yr delay skeletal maturation (n = not reported); n = 93 concomitant 6-MP/azathioprine; n = 9 MTX; n = 56 5-ASA; n = 36 corticosteroids	Yes	> 1 yr delay skeletal maturation	T0; week 30; week 54	All displayed clinical remission to induction regimen prior to randomization	Sig ↑ ht Z from T0 to weeks 30 and 54
Malik et al[27]	Retrospective; adalimumab	n = 36; median age: 14.7 yr; of these, n = 34 prior infliximab (n = 7 non-responders; n = 16 loss of clinical response; n = 11 allergic reaction); n = 23 concomitant immunosuppression; n = 15 corticosteroids	No	n = 17 Tanner 1-3; n = 11 Tanner 4-5	T0; T + 6; n = 11 T + 12	n = 28 clinical remission	Sig ↑ ht Z and HV at T + 6 for whole group, those in clinical remission, Tanner 1-3, immunosuppression, allergic reaction to infliximab; no sig changes for group followed to T + 12; independent of corticosteroid use
Malik et al[28]	Retrospective; infliximab	n = 28; median age: 13.1 yr; n = 17 concomitant 5-ASA; n = 13 azathioprine; n = 13 MTX; n = 12 corticosteroids	Yes	n = 20 Tanner 1-3	T - 6; T0; T + 6; n = 25 T + 12	n = 21 clinical response; n = 10 clinical remission	Sig ↑ ht Z from T0 to T + 6, and T - 6 to T + 12 for whole group; Sig ↑ HV from T0 to T + 6 for whole group, clinical responders, Tanner 1-3, no corticosteroids, MTX throughout
Walters et al[29]	Retrospective; infliximab	n = 27; median age: 14.3 yr; n = 3 concomitant corticosteroids; n = 25 immunosuppression	Yes	n = 9 delayed skeletal maturation; n = 19 Tanner 1-3; n = 8 Tanner 4-5	T0; T + 12; median 26 mo post (current)	n = 20 clinical remission; n = 7 partial remission	Sig ↑ HV from T0 to T + 12 for Tanner 1-3 (and this group displayed growth failure). Within Tanner 1-3, sig ↑ HV from T0 to T + 12 for complete remission; Sig ↑ ht Z from T0 to current for Tanner 1-3; ht Z negatively correlated with disease duration

¹Growth failure defined as mean group height Z-score < -1.00 at pre or initial biologic infusion. ASA: Aminosalicylic acid; MTX: Methotrexate; 6-MP: 6-mercaptopurine; Dx: Diagnosis; T - 12: 12 mo pre commencement; T - 6: 6-mo pre commencement; T0: Commencement of biologic; T + 6: 6 mo post commencement; T + 12: 12 mo post commencement; ht: Height; HV: Height velocity; sig: Significant at P < 0.05; Δ: Change; ↑: Increase; Z: Z-score.