ICCBH2019 Poster Presentations (1) (226 abstracts)
Musculoskeletal deficits persist up to two years despite anti-TNF-alpha antibody therapy in children with Crohn's disease: Results of a prospective, observational inception cohort study
Stefan A Jackowski 1 , Jinhui Ma 2 , Eric I Benchimol 3, , Frank Rauch 5 , Mary B Leonard 6 , Babette S Zemel 7 , Mary Ann Matzinger 8 , Nazih Shenouda 8 , Brian Lentle 9 , Jacob L Jaremko 10 , Karine Khatchadourian 4 , Marie-Eve Robinson 5 , Victor N Konji 1 , Kerry Siminoski 10, , David Mack 3, & Leanne M Ward 4
1Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada; 2Department of Health Research Methods, Evidence, and Impact McMaster University, Hamilton, Canada; 3Department of Pediatrics, CHEO IBD Centre, University of Ottawa, Ottawa, Canada; 4Department of Pediatrics, University of Ottawa, Ottawa, Canada; 5Department of Pediatrics, McGill University, Montreal, Canada; 6Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA; 7Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA; 8Department of Medical Imaging, University of Ottawa, Ottawa, Canada; 9Department of Radiology, University of British Columbia, Vancouver, Canada; 10Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada; 11Department of Medicine, University of Alberta, Edmonton, Canada.
Objectives: To evaluate musculoskeletal trajectories in children with newly diagnosed Crohn’s disease (CD), and to determine whether children treated with anti-tumour necrosis factor-alpha antibody (anti-TNF, TREATED vs NAÏVE) had persistent deficits at two years.
Methods: This was a single-centre prospective, observational inception cohort study. Children with CD underwent assessments within 6.5±9.5 days from diagnosis and annually for two years including: peak jump power (PJP) by jumping mechanography, serum bone turnover markers (BTM), tibia peripheral quantitative computed tomography, and lateral spine x-rays for vertebral fractures (VF).
Results: 73 children were enrolled; 55 completed two years’ follow-up. Thirty-five children were TREATED, 38 NAÏVE, mean age 14.3±2.9 years, 65% boys. Anti-TNF was initiated on average at 9.6±8.9 months. At baseline, age, bone age, anthropometry and the Pediatric Crohn’s Disease Index (PCDAI) were similar, while serum alkaline phosphatase was lower in TREATED children (z-score (Z) median −1.5, range −2.9–2.3, vs −1.1, range −2.9–2.3, P=0.035). PCDAI decreased in both groups, but was higher in TREATED children at three, 12 and 24 months (all, P<0.001). Serum BTM, PJP, muscle cross-sectional area (CSA), and tibia bone measures improved in both groups (all compared to baseline, P<0.028), with the exception of cortical volumetric bone mineral density (vBMD), which declined (both groups, P<0.001). The largest improvements were in PJP (TREATED mean Z change ± SD +1.8±1.4 vs NAÏVE +1.6±1.3, both, P<0.001) and muscle CSA (TREATED Z+0.9±0.8 vs NAÏVE +0.9±0.8, both P<0.001), followed by trabecular vBMD (both, P<0.015) and cortical CSA (both, P<0.024). Despite normalization of BTM in both groups, only TREATED patients had residual deficits at two years (all, P<0.017 vs the healthy average). Cumulative glucocorticoid (GC) dose (mg/m2) was higher in the TREATED vs NAÏVE patients (P=0.016). Two patients (1 NAÏVE, 1 TREATED) had two-year incident VF (one VF each, both mild).
Conclusions: Muscle strength, tibia muscle-bone structure and BMD improved significantly in children with CD undergoing specialist care regardless of treatment modality. Despite these improvements, at two years anti-TNF TREATED patients had higher PCDAI, higher cumulative GC exposure, and significant residual musculoskeletal deficits.
Disclosure: The authors declared no competing interests.
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