Biologics in pediatric Crohn’s disease: is it time to move to an earlier therapeutic approach?

Hyams, Jeffrey S.

doi:10.1586/1744666x.2014.955017

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…Crohn’s disease, characterized by chronic inflammation of the gastrointestinal tract, not only impairs quality of life but also causes growth failure in many children. 23 In the “bottom–up” treatment approach, children are started on “conventional therapies” such as 5-aminosalicylates, corticosteroids, and immunomodulators; infliximab and adalimumab are reserved for those with recalcitrant disease. 23 There is debate in the literature about adopting a “top–down” approach in which the anti-TNF agents would be introduced sooner after diagnosis to prevent disease progression.…”

Section: The Role Of Tnf Blockers In Other Chronic Childhood Diseasesmentioning

confidence: 99%

“… 23 In the “bottom–up” treatment approach, children are started on “conventional therapies” such as 5-aminosalicylates, corticosteroids, and immunomodulators; infliximab and adalimumab are reserved for those with recalcitrant disease. 23 There is debate in the literature about adopting a “top–down” approach in which the anti-TNF agents would be introduced sooner after diagnosis to prevent disease progression. 23 Although the anti-TNF agents have had remarkable success, not every patient has a robust response, which calls into question the possible use of other biologic agents.…”

Section: The Role Of Tnf Blockers In Other Chronic Childhood Diseasesmentioning

confidence: 99%

“… 23 There is debate in the literature about adopting a “top–down” approach in which the anti-TNF agents would be introduced sooner after diagnosis to prevent disease progression. 23 Although the anti-TNF agents have had remarkable success, not every patient has a robust response, which calls into question the possible use of other biologic agents. 23 – 25 …”

Section: The Role Of Tnf Blockers In Other Chronic Childhood Diseasesmentioning

confidence: 99%

“… 23 Although the anti-TNF agents have had remarkable success, not every patient has a robust response, which calls into question the possible use of other biologic agents. 23 – 25 …”

Section: The Role Of Tnf Blockers In Other Chronic Childhood Diseasesmentioning

confidence: 99%

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Efficacy and safety of ustekinumab in adolescents

Kellen¹,

Silverberg²,

Lebwohl³

2016

PHMT

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The biologic agent ustekinumab is a human monoclonal antibody that binds to the p40 subunit shared by interleukins (ILs) 12 and 23. The antibody is able to prevent binding of cytokines to the IL-12Rβ1 cell surface receptor and therefore may prevent IL-23 driven activation of the IL-23/Th 17 axis of inflammation. The anti-inflammatory activity has been beneficial in adult psoriasis. Ustekinumab has been approved in the United States for the treatment of adults with psoriasis and psoriatic arthritis. Approval in children and adolescents has not been granted by the US Food and Drug Administration. Subcutaneous injections of ustekinumab are administered at baseline, week 4 and every 12 weeks thereafter, a regimen that is particularly appealing to young patients who do not like more frequent injections at home. The product is attractive because, although it works through an immune system mechanism, the selective activity is such that the drug has not been associated with many of the side effects attributed to other immunosuppressive medications. Case reports of ustekinumab for pediatric psoriasis have shown promising results, and the recent Phase III CADMUS trial tested the agent in adolescents aged 12–17 years with psoriasis, using standard dose 0.75 mg/kg (≤60 kg), 45 mg (>60–≤100 kg), and 90 mg (>100 kg) or half-standard dosing 0.375 mg/kg (≤60 kg), 22.5 mg (>60–≤100 kg), and 45 mg (>100 kg) with a loading dosage at week 0 and week 4. Psoriasis area and severity index-75 was achieved in more than three-quarters of patients in full and half dosing by 12 weeks, and psoriasis area and severity index-90 in 54.1% and 61.1% of half and full dosage by 12 weeks, respectively. Ustekinumab was generally well tolerated in adolescents, with some patients developing antibodies, and nasopharyngitis being the major adverse event. Ustekinumab is a promising agent in adolescent psoriasis that appears to be well tolerated. The best monitoring plan and usage in younger patients still remain to be defined.

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Section: The Role Of Tnf Blockers In Other Chronic Childhood Diseasesmentioning

confidence: 99%

Section: The Role Of Tnf Blockers In Other Chronic Childhood Diseasesmentioning

confidence: 99%

Section: The Role Of Tnf Blockers In Other Chronic Childhood Diseasesmentioning

confidence: 99%

“… 23 Although the anti-TNF agents have had remarkable success, not every patient has a robust response, which calls into question the possible use of other biologic agents. 23 – 25 …”

Section: The Role Of Tnf Blockers In Other Chronic Childhood Diseasesmentioning

confidence: 99%

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