Early monotherapy with such anti-tumor necrosis factor (TNF)-alpha agents as infliximab (Remicade) or adalimumab (Humira) may produce better overall clinical and growth outcomes than does current standard therapy in children with a new diagnosis of Crohn’s disease.
Standard therapy for children with newly diagnosed Crohn’s disease includes early administration of immunomodulators after initial treatment with corticosteroids, explained Jeffrey S. Hyams, MD, of Connecticut Children’s Medical Center in Hartford, and fellow investigators in Gastroenterology.
Such biologic agents as infliximab and adalimumab are generally reserved for people with Crohn’s disease who have not responded to previous therapy.
The researchers compared the effectiveness of early therapy with an anti-TNF-alpha (treatment administered no more than three months’ postdiagnosis) with that of an immunomodulator in attaining clinical remission and facilitating growth in 204 pediatric patients (younger than age 17 years; median age 11.8 years) with inflammatory (nonpenetrating, nonstricturing) Crohn’s disease.
At one year, 85.3% children on the anti-TNF-alpha therapy had attained remission, compared with 60.3% of those receiving an immunomodulator. Early immunomodulator therapy was similar to no early immunotherapy, with 54.4% of children receiving no early immunotherapy achieving remission at one year.
At the one-year mark, none of the anti-TNF-alpha recipients had a pediatric Crohn’s Disease Activity Index greater than 30, compared with 7% in the early immunomodulator group and 10% in the no-early-immunotherapy group.
In addition, normal growth velocity was established only in the group of children undergoing early anti-TNF-alpha therapy.