The Treatment of Pediatric Inflammatory Bowel Disease with Biologic Therapies

Abstract

Purpose of Review

Biologics for the treatment of inflammatory bowel disease (IBD) have been transformative to the therapeutic goals in the pediatric population. We review the biologics used to treat IBD, highlighting the importance of patient selection, dosing considerations, and therapeutic drug monitoring in children.

Recent Findings

Infliximab is well-established as a safe and efficacious therapy for Crohn’s disease and ulcerative colitis. Both dose escalation strategies and therapeutic drug monitoring increase the likelihood of response to anti-TNFα therapies. Early real-world experience of vedolizumab and ustekinumab in pediatric IBD shows promising results, including clinical response rates comparable to what is seen in adults, but there are limited data using them as first-line therapies.

Summary

Biologic therapies have improved outcomes in pediatric IBD, including achieving mucosal healing as well as improved growth and pubertal development. Therapeutic drug monitoring improves likelihood of response to anti-TNFα therapies, but further studies for vedolizumab and ustekinumab are necessary.

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Abbreviations

ASC:

Acute severe colitis

CD :

Crohn’s disease

IBD:

Inflammatory bowel disease

IBD-U:

Inflammatory bowel disease–unclassified

HLH:

Hemophagocytic lymphohistiocytosis

IFX:

Infliximab

IMM:

Immunomodulator

TNFα:

Yumor necrosis factor alpha

UC:

Ulcerative colitis

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Correspondence to Judith R. Kelsen.

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Conrad, M.A., Kelsen, J.R. The Treatment of Pediatric Inflammatory Bowel Disease with Biologic Therapies. Curr Gastroenterol Rep 22, 36 (2020). https://doi.org/10.1007/s11894-020-00773-3

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Keywords

  • Pediatric inflammatory bowel disease
  • Biologic therapy
  • Children
  • Crohn’s disease
  • Ulcerative colitis
  • Therapeutic drug monitoring