Managing Crohn disease in children and adolescents : focus on tumor necrosis factor antagonists

Area of Science:

• Pediatric Gastroenterology
• Immunology
• Pharmacology

Background:

• Crohn disease (CD) is a chronic gastrointestinal inflammatory disorder with variable symptoms.
• Pediatric CD presents unique challenges, including growth failure and delayed puberty.
• Conventional treatments involve corticosteroids and immunomodulators for moderate to severe cases.

Purpose of the Study:

• To review the efficacy and toxicities of advanced therapies for pediatric Crohn disease.
• To highlight the role of anti-tumor necrosis factor-alpha (TNFalpha) agents in managing refractory pediatric CD.

Main Methods:

• Review of existing literature on anti-TNFalpha agents and other novel therapies in pediatric CD.
• Analysis of clinical trial data and case reports for infliximab, adalimumab, CDP571, and thalidomide.
• Assessment of reported adverse events and toxicities associated with these treatments.

Main Results:

• Infliximab is the most studied anti-TNFalpha agent with demonstrated efficacy in pediatric CD.
• Adalimumab shows efficacy in adults, with limited pediatric data.
• CDP571 and thalidomide have shown some efficacy in small pediatric studies.
• Reported toxicities include infusion reactions, infections, malignancies, and neurological/hematologic issues.

Conclusions:

• Anti-TNFalpha agents, particularly infliximab, represent an important therapeutic option for moderate to severe pediatric CD unresponsive to standard care.
• Careful monitoring for significant toxicities is crucial when using these advanced therapies in children.
• Further research is needed to fully establish the long-term safety and efficacy of agents like adalimumab and thalidomide in pediatric populations.