Monoclonal antibodies against pediatric ulcerative colitis: a review of clinical progress
Debora Curci1, Marianna Lucafò2, Giuliana Decorti3
1Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
Insights
Monoclonal antibodies offer a promising treatment for pediatric ulcerative colitis (UC), improving patient outcomes and quality of life. These advanced therapies provide a safer alternative to corticosteroids, especially for children with severe disease.
Area of Science:
- Pediatric gastroenterology
- Immunology
- Pharmacology
Background:
- Pediatric ulcerative colitis (UC) is often more severe and extensive than in adults.
- Hospitalization for acute exacerbations affects approximately 25% of pediatric UC patients.
- Corticosteroids, commonly used for UC, have significant side effects in children.
Purpose of the Study:
- To review the use of monoclonal antibodies for treating pediatric UC.
- To discuss biologics targeting tumor necrosis factor (TNF)α and other inflammatory pathways.
- To highlight advancements in personalized therapy for pediatric UC.
Main Methods:
- Literature search using keywords: 'pediatric,' 'ulcerative colitis,' 'monoclonal antibodies,' 'infliximab,' 'adalimumab,' 'golimumab,' 'vedolizumab,' 'ustekinumab,' 'risankizumab.'
- Review of current therapeutic strategies and clinical outcomes.
- Analysis of safety profiles and treatment personalization.
Main Results:
- Monoclonal antibody use in pediatric UC has significantly increased.
- These therapies are used in patients refractory to conventional treatments and increasingly as initial therapy.
- Therapeutic drug monitoring and diverse biologic targets enable personalized treatment.
Conclusions:
- Monoclonal antibodies have transformed the treatment landscape for pediatric UC.
- Personalized therapy with biologics improves response rates and quality of life.
- These treatments offer a favorable safety profile for managing pediatric ulcerative colitis.
Introduction:
In children, ulcerative colitis (UC) is often more severe and extensive than in adults and hospitalization for acute exacerbations occurs in around a quarter of subjects. There is a need for effective drugs, which could avoid or reduce the use of corticosteroids which, especially in children, are burdened by a number of severe side effects. The introduction in therapy of monoclonal antibodies has completely changed the therapeutic scenario and the prognosis of the disease.
Areas Covered:
In this review, the use of the monoclonal antibodies directed against tumor necrosis factor (TNF)α or other inflammatory targets for the treatment of pediatric UC will be discussed. A search of the literature was done using the keywords 'pediatric,' 'ulcerative colitis,' 'inflammatory bowel disease,' 'monoclonal antibodies;' 'infliximab,' 'adalimumab,' 'golimumab,' vedolizumab," 'ustekinumab' and 'risankizumab.'
Expert Opinion:
The use of monoclonal antibodies has greatly increased in recent years in pediatric UC, both in patients who did not respond to conventional therapies, and, more often, as initial therapy. Thanks to therapeutic drug monitoring and to the availability of biologics with different targets, therapy has become more targeted and personalized, with a significant improvement in response, in quality of life, and with a good safety profile.
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