Managing pediatric Crohn's disease: recent insights
Katherine Baldwin1,2, Victoria Grossi1,2, Jeffrey S Hyams1,2
1Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, CT, USA.
Insights
Early anti-TNF biologic therapy is crucial for treating pediatric Crohn's disease, offering better outcomes than older treatments. Monitoring drug levels and reassessing inflammation guides effective management for children and adolescents.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Biologic Therapies
Background:
- Crohn's disease in children presents challenges like extensive disease at diagnosis and growth impairment.
- Traditional treatments (corticosteroids, immunomodulators) are less effective than early anti-TNF biologic therapy.
Purpose of the Study:
- Review recent literature on early anti-tumor necrosis factor (TNF) therapy for pediatric Crohn's disease.
- Discuss risks/benefits of combined immunomodulator use and anti-TNF drug monitoring.
- Highlight the importance of endoscopic and imaging reassessment beyond symptom control.
Main Methods:
- Literature review of recent studies on anti-TNF therapy in pediatric Crohn's disease.
- Analysis of data regarding concomitant immunomodulator use.
- Evaluation of therapeutic drug monitoring and reassessment strategies.
Main Results:
- Early anti-TNF therapy is more effective than historical approaches for moderate-to-severe pediatric Crohn's disease.
- Concomitant immunomodulators have specific risks and benefits that require careful consideration.
- Therapeutic drug monitoring and objective reassessment (endoscopy, imaging) improve treatment success.
Conclusions:
- Precision dosing and periodic reassessment of bowel inflammation are standard for pediatric Crohn's disease.
- Predicting anti-TNF response and switching therapies when needed are critical future directions.
- Regulatory delays hinder access to timely and effective treatments for pediatric patients.
Introduction:
Children and adolescents with Crohn's disease present unique challenges due to extensive disease at diagnosis and the effect of bowel inflammation on growth. Historical approaches with corticosteroids and immunomodulators are far less effective than early treatment with anti-TNF biologics.
Areas Covered:
This review covers recent literature delineating the crucial role of early anti-TNF therapy in the treatment of moderate- to- severe Crohn's disease in children and adolescents. The potential risks and benefits of concomitant immunomodulators are discussed, along with therapeutic anti-TNF drug monitoring, and reassessment by endoscopy and cross-sectional imaging to evaluate success beyond symptom control.
Expert Opinion:
Standard of care therapy for moderate-to-severe pediatric Crohn's disease now entails precision dosing of anti-TNF therapy with periodic reassessment of bowel inflammation. The role of dietary modification continues to evolve. Current and future efforts need to be directed to elucidating ways to predict response to anti-TNF therapy and quickly changing to agents with other mechanisms of action when needed. Inordinate regulatory delays in approval of new therapies approved for adults continue to handicap pediatric clinicians and frequently limits their treatment choices, or forces them to give medications "off label." Only a concerted effort by clinicians, pharma, and regulators will improve this situation.
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