Special considerations for biologic medications in pediatric ulcerative colitis
Logan Jerger1, Jeffrey S Hyams1
1Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, USA.
Expert Opinion on Biological Therapy
|October 26, 2019
Summary
Pediatric ulcerative colitis often requires advanced therapies beyond mesalamine. Biologic agents like infliximab and adalimumab show promise, with therapeutic drug monitoring crucial for effective treatment planning in children.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD)
- Ulcerative Colitis (UC) in Children
Background:
- Pediatric inflammatory bowel disease presents unique challenges including disease extent, corticosteroid resistance, and growth impact.
- Ulcerative colitis in children frequently involves pancolitis, with limited efficacy of mesalamine monotherapy, necessitating advanced treatments.
Purpose of the Study:
- To review the current use of biologic therapies in pediatric ulcerative colitis.
- To highlight the limited but growing evidence for agents like infliximab, adalimumab, golimumab, and vedolizumab in children.
Main Methods:
- Literature search using keywords: specific biologic therapies, 'pediatric,' 'ulcerative colitis,' and 'inflammatory bowel disease.'
- Review focused on controlled clinical trials and existing literature regarding biologic use in pediatric UC.
Main Results:
- Paucity of controlled clinical trials limits comprehensive assessment of biologic efficacy and safety in pediatric ulcerative colitis.
- Biologic agents are increasingly considered for refractory pediatric UC cases, though data is still emerging.
Conclusions:
- Biologic therapies represent an important treatment option for pediatric ulcerative colitis, particularly when conventional therapies fail.
- Therapeutic drug monitoring is essential for optimizing dosing and managing treatment changes, playing a key role in future pediatric UC management.
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