Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2015; 21(21): 6613-6620
Published online Jun 7, 2015. doi: 10.3748/wjg.v21.i21.6613
Growth and bone health in paediatric patients with Crohn's disease receiving subcutaneous tumor necrosis factor antibody
Judith Pichler, Wolf Dietrich Huber, Christoph Aufricht, Bettina Bidmon-Fliegenschnee
Judith Pichler, Wolf Dietrich Huber, Christoph Aufricht, Bettina Bidmon-Fliegenschnee, Department of Paediatric and Adolescent Medicine, Medical University Vienna, 1090 Vienna, Austria
Author contributions: The study was designed by Pichler J; The subjects were recruited by Pichler J, Huber WD and Bidmon-Fliegenschnee B; Data collection and analyses were done by Pichler J and Aufricht C; The manuscript was written by Pichler J with the provision of significant advice and consultation by Aufricht C; All authors critically appraised the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Judith Pichler, MD, Department of Paediatric and Adolescent Medicine, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. judith.pichler@meduniwien.ac.at
Telephone: +43-1-404003232 Fax: +43-1-404001080
Received: July 4, 2014
Peer-review started: July 5, 2014
First decision: July 21, 2014
Revised: August 6, 2014
Accepted: December 1, 2014
Article in press: December 1, 2014
Published online: June 7, 2015
Processing time: 341 Days and 19 Hours
Abstract

AIM: To study whether adalimumab (ADA) was associated with improvement in growth, bone mineral density (BMD) and bone metabolism.

METHODS: In children with Crohn’s disease (CD) there is a high prevalence of growth failure and reduced BMD. Treatment with infliximab is associated with an improvement in growth. Anthropometry, paediatric CD activity index (PCDAI), bone markers and BMD was measured in 18 patients (72% females) one year before and after start of ADA with a median age of 14.4 years (range: 5-19 years) at treatment start. Outcomes were indicators of growth with treatment as well as interval growth.

RESULTS: Eleven (61%) children experienced catch-up growth after ADA. PCDAI significantly decreased from 52.1 ± 16 to 30.4 ± 23 (P≤ 0.001). Post ADA, body mass index (BMI) standard deviation score (SDS) 0.1[range: 2.7-(-0.8)] vs -1 [range: 0.1-(-3.6)], P = 0.04 and ∆BMI SDS in children 0.3 [range: 0.7-(-0.2)] vs -1.1 [range: 1.2-(-2.3)], P = 0.01 in remission were significantly higher compared to those with moderate to severe inflammation. The main predictors for growth were 25-hydroxycholecalciferol and for bone mineralisation weight and height SDS. ADA had no significant influence on bone markers and BMD.

CONCLUSION: Next to improvement of PCDAI, half of the children achieved a positive catch-up growth. A better nutritional status with improvement in BMI and weight is positive predictor for improved growth and bone mineralisation.

Keywords: Crohn’s disease; Adalimumab; Growth; Bone health; Paediatrics

Core tip: This cohort study describes the effect of adalimumab (ADA) on growth and bone health by measuring bone density. ADA induced and maintained remission in children with Crohn’s disease that do not respond to infliximab. Next to improvement of paediatric Crohn’s disease activity index, half of the children achieved a positive catch-up growth. A better nutritional status is positive predictor for improved growth and bone mineralisation.