Long-term outcome of tumor necrosis factor alpha antagonist's treatment in pediatric Crohn's disease

Background: Anti tumor necrosis factor alpha (TNF alpha) agents have become widely used in pediatric inflammatory bowel disease (IBD). So far, only few studies examined the long-term results of anti-TNF alpha treatment in children with IBD. Methods: The long-term outcome of pediatric patients with IBD was assessed retrospectively in a multicenter cohort of children treated with anti-TNF alpha beyond induction treatment. Short- and Long-term response rates, predictors for loss of response, data on growth and laboratory parameters were assessed. Results: 120 patients [101 crohn's disease (CD), 19 ulcerative colitis (UC) or indeterminate colitis (IC)] received either infliximab or adalimumab. The mean age at initiation of anti-INF alpha was 13.4 +/- 3.9 years and the median duration of anti-TNF alpha treatment was 15 months (range: 2-90). Overall, 89% of the cohort experienced short-term response following induction. Response was associated with improvement in weight and BMI Z-scores (p<0.001) but not with linear growth. Responders experienced a significant decrease in erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) during treatment (p<0.001). Albumin and hemoglobin both improved but only albumin increased significantly (p<0.001). The cumulative probability of losing response to anti-TNF alpha treatment was 17%, 38%, and 49% after 1, 3, and 5 years, respectively. Responders had a significantly lower weight and BMI Z-scores at initiation of anti-TNF alpha treatment in compared to non-responders (p = 0.04 and 0.02 respectively). Conclusions: Our long term cohort supports the current evidence on the effectiveness and safety of anti-TNF alpha treatment in children with IBD. Response to treatment was interestingly associated with lower weight and BMI. (C) 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.