Balancing and Communicating the Risks and Benefits of Biologics in Pediatric Inflammatory Bowel Disease

Abstract

Anti-tumor necrosis factor agents are now considered to be a vital component of the treatment algorithm for pediatric inflammatory bowel disease. Despite the clear benefit of these agents and the re-alignment of treatment goals to achieve early mucosal healing, the decision to initiate therapy is often delayed due to uncertainties regarding risks and benefits. The purpose of this review is to summarize the currently available data regarding anti-tumor necrosis factor agents in pediatric inflammatory bowel disease. Specifically, we review their expected efficacy in both Crohn’s disease and ulcerative colitis, and the likelihood of side-effects associated with these agents. In addition, we address the barriers physicians face when communicating these data and help to identify how pediatric patients and their parents can be more involved in a shared decision making process. Through the creation of a new decision aid (Option Grid), we hope to allow for a more clear line of communication at the bedside when helping patients and parents make these difficult treatment decisions.

Pediatric Ulcerative Colitis from Prevalence to Outcome

“…Infliximab (IFX), adalimumab, certolizumab pegol and golimumab are the current four anti-TNF-α agents used to treat UC patients [19,27,29]. IFX is an effective treatment for pediatric UC [3,7,19,23]. Anti-TNF-α drugs share the same culoskeletal manifestation in the form of mild arthralgia or severe spondyloarthropathies especially in children positive for HLA-B27 had been also reported [2].…”

“…Biological therapy has potential serious side effects like malignancy and infections and should be avoided in patients with acute infection [3,7]. The patients should be closely monitored for neutropenia and leucopenia to avoid life-threating infections especially if there were on biological therapy or other immunosuppressive medications [7].…”

“…It appears to be safe and well tolerated. It has improved disease control, patient growth and quality of life by pediatric patients with UC [3,7]. Infliximab (IFX), adalimumab, certolizumab pegol and golimumab are the current four anti-TNF-α agents used to treat UC patients [19,27,29].…”

“…Around one-quarter (25%) of patients presents in childhood [7,9]. Most children are diagnosed between 11 and 16 years of age and those who are diagnosed earlier were found to have a more severe disease [10].…”

“…Ulcerative Colitis (UC) is a chronic Inflammatory Bowel Diseases (IBD) [1][2][3][4][5][6] that is characterized by relapses and remissions [2][3][4][6][7][8]. It mainly affects the mucosa and submucosa of the colon [8].…”