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Predicting Therapeutic Response in Pediatric Ulcerative Colitis-A Journey Towards Precision Medicine
Ruben J Colman1, Jasbir Dhaliwal1,2, Michael J Rosen1,2
1Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Insights
Personalized medicine is crucial for treating pediatric ulcerative colitis (UC). Identifying predictors of treatment response can optimize care, improve quality of life, and guide future therapies for children with UC.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Precision Medicine in Pediatrics
Background:
- Ulcerative colitis (UC) is a growing global health concern in children.
- Current UC treatment for pediatric patients is often uniform, despite varying disease characteristics.
- Advances in biologics and small molecules necessitate personalized treatment strategies.
Purpose of the Study:
- To review predictors of treatment response in pediatric ulcerative colitis.
- To discuss special considerations for specific UC scenarios in children.
- To explore the future role of machine learning in pediatric UC precision medicine.
Main Methods:
- Review of clinical, biochemical, histopathologic, and molecular data.
- Analysis of treatment response predictors in pediatric UC.
- Examination of special treatment considerations for distinct UC presentations.
Main Results:
- Identified various predictors of treatment response in pediatric ulcerative colitis.
- Highlighted specific treatment considerations for early-onset UC, severe cases, and related conditions.
- Emphasized the need for tailored approaches beyond uniform treatment.
Conclusions:
- Precision medicine is essential for optimizing pediatric ulcerative colitis management.
- Predictor identification is key to achieving sustained remission and improving quality of life.
- Machine learning holds promise for advancing personalized UC care in children.
Abstract:
Ulcerative colitis (UC) is a disabling disease, characterized by chronic inflammation of the colon, with a rising prevalence worldwide in the pediatric age group. Although UC presents in children with varying severity, disease extent, and comorbidities, initial treatment is essentially uniform, consisting of 5-aminosalicylate drugs with corticosteroid induction for those with moderately to severely active disease. With the advent of anti-tumor necrosis factor (TNF) biologic therapy and several new biologics and small-molecule drugs for UC, precision medicine approaches to treatment are needed to more rapidly achieve sustained remission, restore quality of life, normalize development, and limit exposure to toxic corticosteroids in children with UC. Here, we review available data on clinical, biochemical, histopathologic, and molecular predictors of treatment response in UC. We also address known predictors and special treatment considerations in specific relevant scenarios such as very-early-onset UC, acute severe UC, ileal pouch anal anastomosis, and UC with concomitant primary sclerosing cholangitis. The review concludes with a prediction of how machine learning will integrate multimodal patient data to bring precision medicine to the bedside of children with UC in the future.
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