Biologics in paediatric Crohn's disease
Oliver Gouldthorpe1, Anthony G Catto-Smith, George Alex
1Department of Paediatrics, Monash University, Clayton, VIC 3800, Australia.
Insights
Biologic drugs effectively control Crohn's disease in children, improving growth. Long-term safety data is limited, but these treatments are crucial for children unresponsive to conventional therapies.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Clinical Pharmacology
Background:
- Childhood-onset Crohn's disease is increasingly prevalent and often more severe than adult-onset.
- Pediatric Crohn's disease significantly impacts children's quality of life and growth.
- Therapeutic strategies in children must consider unique toxicity risks and long-term outcomes.
Purpose of the Study:
- To review the efficacy and safety of biologic therapies in pediatric Crohn's disease.
- To highlight the benefits of biologics for disease control and growth in children.
- To identify gaps in knowledge regarding long-term risks and outcomes of biologics in pediatric patients.
Main Methods:
- Review of existing literature and case series on biologic drug use in children with Crohn's disease.
- Analysis of data on disease activity control, growth parameters, and adverse events.
- Assessment of available information on specific biologic agents like infliximab, adalimumab, certolizumab, and natalizumab.
Main Results:
- Biologic therapies show promising results in controlling pediatric Crohn's disease activity and improving growth.
- Short-term adverse reactions to biologics in children appear infrequent.
- Loss of response is a notable long-term challenge, particularly in pediatric populations.
Conclusions:
- Biologics offer significant advantages for managing pediatric Crohn's disease, especially when conventional therapies fail.
- While short-term safety is generally favorable, extensive long-term data is still required.
- Current data limitations should not impede access to essential biologic treatments for children with refractory disease.
Abstract:
Crohn's disease affects increasing numbers of children worldwide. Generally, childhood-onset disease runs a more severe course than in adults and has a greater impact on quality of life. Therapy in children must take account of a different set of risks for toxicity compared to adults, but also to their longevity. Biologic drugs present remarkable advantages in terms of disease control for children, especially in those whose disease cannot be controlled with conventional therapies, but their long-term risks are still being assessed. Data regarding biologic use in children is limited and mostly amounts to case series, but results have been promising, both in terms of controlling disease activity and improving growth parameters. Adverse reactions are infrequent in the short term, but loss of response is a long-term problem, particularly in children. More information is needed about very long term risks. Infliximab and adalimumab are the most studied agents in children, while there is relatively limited data on certolizumab and natalizumab. Further collection of data on these agents is still needed, but this should not restrict access to these agents for children in whom no other agent is effective.
Related Concept Videos
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:25Inflammatory Bowel Disease III: Crohn's Disease
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the colonic...