title: Adjunctive treatment to antitumor necrosis factor in pediatric patients with refractory Crohn's disease.
abstract: OBJECTIVE
  The use of antitumor necrosis factor (anti-TNF) agents to treat Crohn's disease in children has become quite common over the past decade. There are incomplete data to guide the clinician in choosing whether adjunctive therapy should be added to optimize response to these drugs.
  
  
  RESULTS
  Addition of immunomodulators such as thiopurines or possibly methotrexate can increase anti-TNF drug levels, reduce the risk of antidrug antibodies, and improve response. This is tempered by the reports of younger patients developing hepato-splenic T-cell lymphoma while taking thiopurines with and without concomitant anti-TNF medications. The available data are reviewed including recent pediatric reports.
  
  
  CONCLUSIONS
  The addition of immunomodulators to anti-TNF therapies can optimize their performance. Careful discussion of the risks and side-effects must be undertaken when considering this approach. Additional knowledge is required to stratify which children with inflammatory bowel disease need this approach, and/or who are at risk for significant complications.
authors.affiliation: aDivision of Gastroenterology and Hepatology bDivision of Pediatric Gastroenterology and Hepatology at Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Imad
authors.initials: I
authors.lastname: Absah
authors.forename: Michael
authors.initials: M
authors.lastname: Stephens
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha