title: Balancing and communicating the risks and benefits of biologics in pediatric inflammatory bowel disease.
abstract: : Anti-tumor necrosis factor agents are now considered to be a vital component of the treatment algorithm for pediatric inflammatory bowel disease. Despite the clear benefit of these agents and the realignment of treatment goals to achieve early mucosal healing, the decision to initiate therapy is often delayed due to uncertainties regarding risks and benefits. The purpose of this review was to summarize the currently available data regarding anti-tumor necrosis factor agents in pediatric inflammatory bowel disease. Specifically, we review their expected efficacy in both Crohn's disease and ulcerative colitis and the likelihood of side effects associated with these agents. In addition, we address the barriers physicians face when communicating these data and help to identify how pediatric patients and their parents can be more involved in a shared decision-making process. Through the creation of a new decision aid (Option Grid), we hope to allow for a more clear line of communication at the bedside when helping patients and parents make these difficult treatment decisions.
authors.affiliation: *Inflammatory Bowel Disease Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; and †Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Parambir S
authors.initials: PS
authors.lastname: Dulai
authors.forename: Corey A
authors.initials: CA
authors.lastname: Siegel
authors.forename: Marla C
authors.initials: MC
authors.lastname: Dubinsky
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001685:Biological Factors / Q000627:therapeutic use*; D002648:Child; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D003657:Decision Making; D006801:Humans; D018570:Risk Assessment; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D001685:Biological Factors; D014409:Tumor Necrosis Factor-alpha