Are anti-tumor necrosis factor (TNF)-alpha agents more effective than an immunomodulator for the treatment of pediatric Crohn disease?

Updated: Oct 23, 2018
  • Author: Andrew B Grossman, MD; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Data from the observational RISK study has been published. The study included children from 28 pediatric gastroenterology centers in North America. Results showed that in newly diagnosed children with comparably severe Crohn disease, early monotherapy with and anti-TNF-alpha agents produced better overall clinical and growth outcomes at 1 year than early monotherapy with an immunomodulator. Further investigation is needed to identify which children are most likely to benefit from early anti-TNF-alpha therapy. [31]

A study examined changes in bone density and structure in children and adolescents with Crohn's disease following initiation of anti-tumor necrosis factor (TNF)-alpha inhibitors therapy. The study concluded that anti-TNF-α therapy was associated with improvements in trabecular bone mineral density and cortical structure. Improvements were greater in younger and growing participants, suggesting a window of opportunity for treatment of bone deficits. [32, 33]

Another study that included 75 pediatric patients with Crohn disease reported that after the initiation of anti-TNF-α therapy, short-term increases in insulinlike growth factor 1 z scores predicted recovery of bone and muscle outcomes. [40]


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