Volume 11 Supplement 2
PReS-FINAL-2090: Efficacy of anti-TNF drugs from the perspective of growth velocity: a single center experience
© Mrážik and Vargová; licensee BioMed Central Ltd. 2013
Published: 5 December 2013
Growth is a sensitive marker of well-being in children. In patients with juvenile idiopathic arthritis (JIA) both, ongoing inflammation and corticosteroid treatment, may affect linear growth adversely, potentially leading to irreversible growth retardation. Biologic treatment of JIA may have the potential to enable normal growth in children with JIA.
To retrospectively evaluate the safety, clinical efficacy, corticosteroid-dose and impact on linear growth of biologics in children with JIA in The center of the biological treatment for children with chronic rheumatic diseases in Košice.
- DMARDs-resistant polyarticular course of JIA receiving anti-TNF treatment at least one year.
- Evaluation of response every 3 months by Pediatric American College of Rheumatology Response Criteria (ACR Paed).
- no growth expected boys: Tanner staging sexual maturity score V plus age 17 before starting anti-TNF treatment
- no growth expected girls: menarche at least two years before starting anti-TNF treatment or menarche at least a year before starting treatment plus Tanner staging sexual maturity score IV
Growth velocity was defined by change of height in standard deviation (SD) score. To calculate exact SD score software Rust CZ 2.0, based on anthropometric data of Czech paediatric population - the nearest one to Slovak paediatric population, was used. Catch-up was defined as positive growth velocity.
The group of 20 patients with expected growth (boys vs. girls: 10 vs. 10; etanercept vs. adalimumab: 16 vs. 4) was assessed. The mean age at anti-TNF treatment initiation was 12.03 years (SD ± 4.44). Median duration of disease was 3.25 years (range 0.89-10.23), 15 patients received corticosteroids in mean dose 0.273 mg/kg/day.
All patients were identified as "responders" (ACR Paed 30) at 3 months. One patient was a ...secondary non-responder" at 6 months, but completed 12 months of treatment. The daily dose of corticosteroids at 12 months was significantly reduced to 0.07 mg/kg/day (p < 0.001) and could be stopped in 10 of 15 patients. Growth catch-up was observed in 16 of 20 patients with median growth velocity being 0.325 (range -0.2 to 0.94). Two patients did not show growth during the first year of treatment.
Anti-TNF treatment of JIA is highly effective and has a rapid corticosteroid-sparing effect in DMARDs-resistant JIA with polyarticular course. The clinical response is accompanied by an increase in growth rate (catch-up) in most cases.
Disclosure of interest
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.