Endocrine Abstracts

Introduction: Treatment with anti-TNFα therapy such as infliximab may improve growth in children with CD but the extent of improvement in growth and its relationship to pubertal progress and changes in glucocorticoid therapy are unclear.

Aim: A retrospective study of growth, puberty and disease activity over the 6 months prior (T−6) to starting infliximab, at baseline (T0) and for the following 6 months (T+6) in CD. Results are expressed as median(10th, 90th).

Subjects & Methods: The growth and treatment details of 28 children (M:17) who were started on infliximab at a median (10th, 90th) age of 13.1yr(10.0,15.7) were reviewed. In 20 children, pubertal data were also available at all time points. Data on disease markers (CRP, ESR, and Albumin),total Alkaline Phosphatase (ALP) and a physician global assessment were also collected.

Results: Out of 28 cases, 21(75%) demonstrated a clinical response to infliximab treatment. Overall, height velocity(HV) increased from 3.6 cm/year (0.4, 7.8) at T0 to 5.5 cm/year (2.1, 9.2) at T+6 (P=0.003). In infliximab responders, HV increased from 1.9 cm/year (0.3, 7.1) to 6 cm/year (2.3, 9.1) (P=0.003) and in the non-responders, HV remained static at 4.3 cm/year (2.5, 8.6) at T0 and 3.0 cm/year (2.0, 11.3) (NS) at T+6. HV also increased in the subgroup of 13 children who had remained prepubertal from 4.5 cm/year (0.4, 8) to 5.5 cm/year (3.3, 8.4) (P=0.05). In the subgroup of 11 children who had a reduction (n, 2) or cessation in GC (n, 9), HV increased from 1.8 cm/yr (0.3, 8.3) at T0 to 5.6 cm/year (2.2, 9.2) at T+6 (NS),whereas those children who did not receive GC over the12 months had an increase from 3.7 cm/year (0.6, 6.5) to 6.4 cm/yr (2.9, 9.0) (P<0.05). HV at T0 and T+6 showed a significant association with the average ALP over the prior 6 months (r, 0.39, P<0.05). HV didn’t show any association with individual markers of disease activity.

Conclusion: Clinical response to infliximab therapy is associated with an improvement in linear growth in children with CD. This increase is also seen in prepubertal and GC naïve children and cannot solely be attributed to a change in these factors.