A newly published retrospective study found that patients who received a combination therapy with infliximab and azathioprine early on had significantly increased linear growth compared to patients whose therapy was stepped up.
Conventionally, treatment for pediatric Crohn disease (CD) has focused on inducing remission with corticosteroids and maintaining remission with immunomodulators. Those patients who are refractory or intolerant to such a treatment approach are sometimes considered candidates for treatment with infliximab (an approach known as “step-up” therapy), but data on the use of early infliximab treatment in pediatric patients with CD have thus far been limited.
Information about growth failure in pediatric patients with CD has also been limited, though growth failure is recognized as a characteristic of the disease; proposed factors contributing to the problem are chronic undernutrition and the presence of inflammatory cytokines secreted from the intestine. Use of corticosteroids also increases the risk of growth failure.
A newly published retrospective study, appearing in Gut and Liver, sought to evaluate the impact of different treatment approaches on linear growth of pediatric patients with CD, and found that patients who received a combination therapy with infliximab and azathioprine early on had significantly increased linear growth compared to patients whose therapy was stepped up.
A total of 33 patients were included in the study; 16 had been allocated to the step-up group and 17 to the early combined immunosuppression group. Patients in the step-up group received an oral corticosteroid dose of 1 mg/kg daily for induction therapy, which was tapered over 8 weeks, and oral azathioprine and mesalazine for maintenance therapy (infliximab could be added in this group if necessary to maintain clinical remission). The early combined immunosuppression group received infliximab at infused doses of 5 mg/kg at weeks 0, 2, and 6 for induction, and every 8 weeks thereafter. Patients in this group initiated azathioprine at daily doses of 0.5 to 1 mg/kg, and doses were adjusted as required.
Z-scores for height (which measure children’s stature for age) for the 2 groups were as follows at 1, 2, and 3 years after diagnosis:
“Our study showed that an early combined immunosuppression strategy was superior to step-up strategy in improving long-term height z-scores,” write the authors, who add that “long-term restoration of linear growth was superior in the early combined immunosuppression when compared from diagnosis.” The authors conclude that early introduction of biologics at the time of diagnosis with pediatric CD should be considered in terms of improving linear growth.
The Growing Impact of Biosimilars in IBD Care
April 23rd 2025Biosimilars are proving to be a game-changing solution in the fight against inflammatory bowel disease (IBD), offering a cost-effective alternative to biologics with similar efficacy and safety, while innovative drug delivery systems promise to further enhance treatment outcomes and accessibility for millions worldwide.
How AI Can Help Address Cost-Related Nonadherence to Biologic, Biosimilar Treatment
March 9th 2025Despite saving billions, biosimilars still account for only a small share of the biologics market—what's standing in the way of broader adoption and how can artificial intelligence (AI) help change that?
Biosimilar and Biologic Use Increasing in Greek Patients With IBD
April 19th 2025A retrospective study from a single inflammatory bowel disease (IBD) center in Greece reported that from 2018 to 2022, the use of biologics increased by 28% yearly, and the proportion of patients using biosimilars grew from 33% to 67%.
Will the FTC Be More PBM-Friendly Under a Second Trump Administration?
February 23rd 2025On this episode of Not So Different, we explore the Federal Trade Commission’s (FTC) second interim report on pharmacy benefit managers (PBMs) with Joe Wisniewski from Turquoise Health, discussing key issues like preferential reimbursement, drug pricing transparency, biosimilars, shifting regulations, and how a second Trump administration could reshape PBM practices.
Latest Biosimilar Deals Signal Growth Across Immunology, Oncology Markets
April 14th 2025During Q1 2025, pharmaceutical companies accelerated biosimilar expansion through strategic acquisitions and partnerships in hopes of boosting patient access to lower-cost treatments in immunology and oncology.
Early Success of Adalimumab Biosimilars Featured at AMCP 2025
April 5th 2025High adherence rates, comparable clinical effectiveness, and cost savings have marked the early adoption of adalimumab biosimilars in the US, particularly in formulary-driven transitions, as shown in 2 retrospective studies presented at the Academy of Managed Care Pharmacy annual meeting (AMCP 2025).