[Role of anti-TNF therapy (biologics) in the treatment of chronic inflammatory bowel disease in children].
Inflammatory bowel disease (IBD) is diagnosed already during childhood or adolescence in every fourth patient. Compared to adult population, whereby recent studies show a tendency towards stabilization, incidence rates for children continue to rise. Though many features are shared with adult onset disease, paediatric ulcerative colitis and Crohn's Disease are, both, more aggressive and extensive already at diagnosis, with disease behaviour that changes with time. Therapeutic approaches, therefore, have to be adapted to specific needs of paediatric population. Aim of the article was to formulate guidelines on the role of biologic therapy in the treatment of paediatric onset inflammatory bowel disease, namely on the use of anti-TNF agent infliximab as it is the only biologic drug registrated for use in children with IBD. Recommendations are based on systematic review of the evidence in paediatric patients whenever it was available. However, due to lack of good randomised studies, adult practice was also taken into consideration. Finally, recommendations were dis-cussed on the consensus conference of all experts participating in the development of guidelines for adult and paediatric pa-tients.The recommendations are developed for Crohn's Disease and for Ulcerative Colitis, separately with respect to remission induction and for relapse prevention. Level of evidence is stated and following this procedure, recommendations are graded. Practice points are also provided with the aim to guide clinicians on the ward how to use biologics in the clinical practice. Com-plications of the treatment that are specific for children with inflammatory bowel disease are also addressed. These guidelines and practice points provide a structured guide for the use of anti-TNF therapy in the treatment of Crohn's Disease and Ulcerative Colitis in paediatric patients.
Referentni centar za djecju gastroenterologiju i poremećaje prehrane, Klinika za djedje bolesti Zagreb, Medicinskifakultet Sveucilista u Zagrebu, Zagreb, Hrvatska. sanja.kolacek@gmail.com
Sanja
S
Kolacek
D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000517:prevention & control; D003424:Crohn Disease / Q000188:drug therapy; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000517:prevention & control; D000069285:Infliximab; D017410:Practice Guidelines as Topic; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab