Novel pharmacological developments in the management of paediatric inflammatory bowel disease: Time for guideline
Rachel By Lee1, Marco Gasparetto2,3
1Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Insights
Novel pharmacological treatments show promise for paediatric inflammatory bowel disease (IBD) management, offering new hope for children unresponsive to current therapies. Further research is needed to confirm their safety and efficacy in this population.
Area of Science:
- Gastroenterology
- Paediatric Medicine
- Pharmacology
Background:
- Paediatric inflammatory bowel disease (IBD) incidence is rising globally.
- Over one-third of patients with IBD show a lack of response to anti-tumour necrosis factor (TNF) biologics and immune modulators.
Purpose of the Study:
- To review novel pharmacological developments in paediatric IBD management.
- To highlight new biological therapies for children with IBD.
Main Methods:
- A comprehensive literature search of PubMed Medline was conducted for studies published between 2018 and January 2023.
- Included were randomised controlled trials, observational studies, case reports, and relevant guidelines from paediatric and adult gastroenterology societies.
- Non-pharmacological treatments were excluded.
Main Results:
- Newer biologics and small molecules, including anti-integrins and interleukin inhibitors, demonstrate safety and efficacy in adult IBD.
- Emerging evidence suggests these novel agents are also promising for paediatric IBD.
- Specific agents investigated include Janus kinase (JAK) and signal transducer and activator of transcription (STAT) protein inhibitors.
Conclusions:
- Novel pharmacological treatments offer advancements in IBD management, but further research is essential to validate their paediatric safety and effectiveness.
- Expanding the approved use of these novel treatments to children is critical due to increasing treatment resistance.
- International guidelines must be updated to integrate these new therapeutic options into existing paediatric IBD protocols.
Aim:
The incidence of paediatric inflammatory bowel disease (IBD) continues to increase in both adults and children across the globe, with more than one third of the patients not responding to anti-tumour necrosis factor biologics and immune modulators. This narrative review provides an overview of novel pharmacological developments in the management of paediatric IBD, including new biological therapies.
Methods:
A PubMed Medline search was performed to include randomised controlled trials, retrospective and prospective observational studies, and relevant case reports of children with IBD published between 2018 and January 2023. Guidelines and protocols from relevant paediatric and adult gastroenterology societies, such as the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn's and Colitis Organisation, were also included. Non-pharmacological treatments including therapeutic diets and faecal microbiota transplantation were outside the scope of this work.
Results:
Early real-world evidence suggests that newer biologics and small molecules, such as anti-integrins, interleukin-12 and/or interleukin-23 inhibitors, Janus kinase and signal transducer and activator of transcription proteins inhibitors, are safe and effective in adult patients with IBD, with promising growing evidence for paediatric IBD.
Conclusion:
While many developments have been achieved with novel pharmacological treatments to manage IBD, ongoing research is required to confirm their effectiveness and safety in the paediatric age. Extending the licence of novel treatments to children will be crucial to tackle the increasing loss of response to conventional treatments. International guidelines will require timely updating to incorporate novel treatments within the existing protocols.
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