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Medical therapy of paediatric inflammatory bowel disease

Nature Reviews Gastroenterology & Hepatology volume 19, pages 685–686 (2022)Cite this article

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Antibodies targeting tumour necrosis factor have substantially advanced the treatment of paediatric inflammatory bowel disease. Understanding pharmacokinetics and therapeutic drug monitoring has led to increased efficacy and durability of response. Primary non-response is more common in ulcerative colitis than in Crohn’s disease, highlighting the need for alternative biologic agents and oral small molecules.

The incidence and prevalence of inflammatory bowel diseases (IBDs) among children and adolescents are increasing worldwide, including in countries where both Crohn’s disease and ulcerative colitis were previously uncommon. Unique challenges in treating children stem from their anticipated long lives ahead, during which disease-related complications might occur and the potential, particularly in Crohn’s disease, for cytokines released from the chronically inflamed intestine to impede linear growth. The advent of biologic therapies, especially monoclonal antibodies targeting tumour necrosis factor (anti-TNFs), ushered in a new era in the management of paediatric IBD. Their greater efficacy than in so-called conventional therapies has enabled treatment targets to move beyond the control of symptoms and facilitation of normal linear growth and towards intestinal healing, aiming to prevent disease-associated complications1. In the RISK prospective cohort study of 913 children with new-onset inflammatory Crohn’s disease, early anti-TNF use was associated with a reduced risk of progression to penetrating disease over 3 years of follow-up, but, disappointingly, it did not affect progression to stricturing disease2. The treat-to-target paradigm, a strategy based on regular assessment of inflammation using objective measures and the subsequent adjustment of therapies1, has been incorporated into paediatric IBD management. This Clinical Outlook aims to highlight current best practices and controversies in the management of paediatric Crohn’s disease and ulcerative colitis, recognizing that worldwide access to specific treatments is far from uniform.

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Authors and Affiliations

  1. IBD Centre, Department of Paediatrics, SickKids Hospital, University of Toronto, Toronto, Ontario, Canada

    Luca Scarallo & Anne M. Griffiths

  2. Meyer Children’s Hospital, University of Florence, Florence, Italy

    Luca Scarallo

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  1. Luca Scarallo
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  2. Anne M. Griffiths
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Correspondence to Anne M. Griffiths.

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Competing interests

A.M.G. has been a consultant for Abbvie, Amgen, Bristol Myers Squibb, Janssen, Lilly, Merck, Pfizer and has received speaker fees from Abbvie and Janssen. L.S. declares no competing interests.

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Scarallo, L., Griffiths, A.M. Medical therapy of paediatric inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 19, 685–686 (2022). https://doi.org/10.1038/s41575-022-00686-8

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