P603 Anti-TNF treatment is effective in inducing remission and restoring nutritional status in pediatric inflammatory bowel disease

Abstract

Background: Tumour necrosis factor alpha (TNF-a) plays an important role in malnutrition and growth retardation in paediatric inflammatory bowel disease (IBD) due to perpetuation of chronic inflammation. One of the objectives in the management of these patients should be to optimize their growth, which may be compromised due to uncontrolled disease and the effect of steroids. We aimed to study anti-TNF treatment effect on nutritional recovery in paediatric IBD, in relation to their efficacy in clinical response, both in shortand medium-term. Methods: Retrospective analysis of our paediatric IBD patients treated with anti-TNF between January 2002 and December 2010. We evaluated clinical response as defined by changes in activity scores (Paediatric Crohn’s Disease Activity Index [PCDAI] and Paediatric Ulcerative Colitis Activity Index [PUCAI]) at 2 and 8 weeks, 6 months and 1 year after its initiation. Changes in anthropometric measures (height and weight for age and body mass index [BMI]) and biochemical modifications (ESR, CRP, haemoglobin, platelets and albumin) were evaluated at 6 and 12 months. Results: 54 patients (34 boys) received anti-TNF (44 CD, 8 UC, 2 IBDU). Age at diagnosis: 11 years 5 months. Mean time from diagnosis to anti-TNF treatment: 17 months (range 0 121). Mean age at first infusion 13 years (1.1 17.3). Mean followup 35 months and mean number of infusions per patient 17. Forty-one patients received infliximab (IFX), 21 adalimumab (ADA) and 1 certolizumab pegol. Thirty-one patients (63%) had not previously received steroids. Mean basal PCDAI and PUCAI: 28.6 (2.5 62) and 39 (27 55) respectively. Clinical response was achieved in 47 cases (87%). Remission rate was 74.2% at 2 weeks, 87.7% at 8 weeks, 90% at 6 months, and 90.6% at 12 months. Seven patients experienced a relapse at some point of the follow-up. Median steroid-free time from the beginning of anti-TNF was 25.9 months (1 76). Mean BMI prior to treatment was 17, z-score 1.04 ( 4.2, +1.64). We observed improvement of anthropometry, with a mean BMI of 19.2 [z-score 0.27 ( 2.3, +1.78)] after 12 months. Biochemical parameters improvement was also observed at 6 and 12 months, with significant reduction of inflammatory markers and increase in haemoglobin and albumin levels. Conclusions: Anti-TNF treatment shows high efficacy in obtaining and maintaining clinical remission in paediatric IBD. Furthermore it has a positive impact on the nutritional status. This effect is parallel to the decrease in disease activity.