title: The use of biologic agents in pediatric inflammatory bowel disease.
abstract: OBJECTIVE
  Therapeutic options and approaches in inflammatory bowel disease (IBD) continue to evolve. This review will summarize the recent studies of treatment strategies, efficacy, safety and outcome of biological agents in the treatment of children with Crohn's disease and ulcerative colitis.
  
  
  RESULTS
  Although there has been little recent change in the number of biologicals easily available for the treatment of children, usage has broadened in pediatric IBD and new treatment strategies have emerged. The use of biologicals in refractory pediatric ulcerative colitis is now accepted, with evidence supporting their potential for maintenance therapy. In pediatric Crohn's disease, scheduled treatment regimens have shown superiority to episodic treatment. Although the 'top-down' approach with early use of biologicals produces superior remission rates in adults, there is still little evidence in children. Concomitant immunosuppression appears to reduce immunogenicity and improve therapeutic control, but there are added risks for infection and malignancy.
  
  
  CONCLUSIONS
  Biologicals now form an integral part of the treatment algorithm in childhood IBD and their use is likely to increase. Treatment regimens, particularly those involving concomitant immunosuppressants, need to take account of the perceptions of risk.
authors: St Vincent's Hospital Clinical School, The University of Melbourne, Melbourne, Victoria, Australia.
authors: Linda S
authors: LS
authors: Yang
authors: George
authors: G
authors: Alex
authors: Anthony G
authors: AG
authors: Catto-Smith
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D019317:Evidence-Based Medicine; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D000069285:Infliximab; D008297:Male; D000069442:Natalizumab; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D001688:Biological Products; D005765:Gastrointestinal Agents; D000069442:Natalizumab; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab