Use of biologic agents in pediatric inflammatory bowel disease.
OBJECTIVE
Owing to its aggressive clinical course and associated immunologic abnormalities, pediatric inflammatory bowel disease (IBD) is increasingly managed with immunomodulators and biologic agents. Clinical experience with therapy targeted against tumor necrosis factor-alpha has raised important questions about these agents, which will be addressed in this review.


RESULTS
Pediatric IBD is increasingly appreciated to have a variety of recognized clinical phenotypes that are associated with particular genotypes and serologic responses. These observations may ultimately allow individualized therapy that could change the natural history of pediatric IBD and reverse its severe metabolic and growth effects. Several new studies suggest that antitumor necrosis factor therapy could be an important part of this therapeutic vista. In addition to shedding light on who could best benefit from such agents, optimization of such therapy and its safety have been active areas of recent research.


CONCLUSIONS
Biologic therapy for pediatric IBD is an increasingly employed strategy. The aggressive nature of the disease and its consequent metabolic effects make this an attractive option for many patients. Recent research is helping guide the clinician to identify who could best benefit from such therapy while also exploring its safety and ideal dosing strategy.
Rosh
Joel R
JR
Division of Pediatric Gastroenterology, Goryeb Children's Hospital at Atlantic Health, Morristown, New Jersey 07962, USA. joel.rosh@atlantichealth.org
D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D018579:Patient Selection
D000893:Anti-Inflammatory Agents; D007155:Immunologic Factors