Biological Therapy in Pediatric Inflammatory Bowel Disease

Abstract

The incidence of inflammatory bowel disease (IBD) has increased steadily worldwide, both in adult and in children; approximately 25% of IBD patients are diagnosed before the age of 18. The natural history of IBD is usually more severe in children than in adults, and can be associated with linear growth impairment, delayed puberty onset, reduced bone mass index, malnutrition, and the need for surgery. Biological therapies, especially blocking tumor necrosis factor-α (TNFα), have radically modified the treatment strategies and disease course of IBD in children. In particular, drugs such as Infliximab and Adalimumab are routinely used in the treatment of pediatric IBD. The role of Infliximab and Adalimumab in the management of pediatric IBD has been recently updated in the Consensus guidelines of ECCO/ESPGHAN. Data regarding short-term and long-term efficacy and safety of these drugs in children, and the effects of "top-down" and "step-up" strategies, are lacking. In this paper, the authors will review current indications, efficacy, and safety of biological therapy in pediatric IBD patients, evaluating all articles published after ECCO/ESPGHAN guidelines publication. The authors carried out a systematic search through MEDLINE through PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) Embase, CINAHL, Cochrane Library, and gray literature, from January 2013 to January 2016. Anti-TNFα has been shown to be effective and safe to maintain remission and to achieve mucosal healing. Multicenter trials based on large sample size cohorts are needed to better clarify long-term efficacy of anti-TNFα and the real incidence of treatment-related complications in pediatric IBD.

Switching biologics in severe pediatric psoriasis: a retrospective analysis

“…reported no safety concerns in 69 children treated with etanercept for 5 years . Additionally, safety data from studies of pediatric inflammatory bowel disease and juvenile arthritis treated with biologics is reassuring, demonstrating a favorable long‐term safety profile that overlaps with Paller et al and our findings …”

Premedication with intravenous steroids does not influence the incidence of infusion reactions following infliximab infusions in pediatric inflammatory bowel disease patients—a case-control study

“…It has become a highly valuable therapy for IBD patients in adults as well as in children [3]. IFX is efficient both in inducing and in maintaining remission [4], although infusion reactions (IR) are relatively commonly observed side effects, especially in children (12.3-38.6% of patients) [5][6][7]. No consensus exists on the exact definitions of IR [8], but most commonly described IR against IFX include pruritus, flushing, and dyspnea [2,5].…”

Meta-Analysis of Expression Profiling Data Indicates Need for Combinatorial Biomarkers in Pediatric Ulcerative Colitis

“…Of the three datasets, two were from colonic biopsies, namely, GSE9686 [12] and GSE10616 [13] and one from WBC, GSE119600 [14]. These datasets are summarised in Table 1 5,296 DEGs that overlapped between the two datasets ( Figure 1(a)). Interestingly, the five most significant DEGs were the same, namely, SLC6A14, DUOX2, MMP1, MMP3, and MMP10.…”

“…Increasing prevalence and hospitalization rates have been reported [1][2][3]. Early diagnosis and monitoring of disease are important to prevent progression, but complicated by highly variable disease manifestations, which may not only affect the gastrointestinal tract but also the skin and eyes [4][5][6]. Therefore, there is a great need for reliable biomarkers for early diagnosis and disease monitoring [7][8][9][10].…”