title: Use of Placebo in Pediatric Inflammatory Bowel Diseases: A Position Paper From ESPGHAN, ECCO, PIBDnet, and the Canadian Children IBD Network.
abstract: Performing well-designed and ethical trials in pediatric inflammatory bowel diseases (IBD) is a priority to support optimal therapy and reduce the unacceptable long lag between adult and pediatric drug approval. Recently, clinical trials in children have been incorporating placebo arms into their protocols under conditions that created controversy. Therefore, 4 organizations (the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; European Crohn's and Colitis Organization; the Canadian Children IBD Network; and the Global Pediatric IBD Network) jointly provide a statement on the role of placebo in pediatric IBD trials. Consensus was achieved by 94 of 100 (94%) voting committees' members that placebo should only be used if there is genuine equipoise between the active treatment and placebo; for example, this may be considered in trials of drugs with new mechanisms of action without existing adult data, especially when proven effective alternatives do not exist outside the trial. Placebo may also be used in situations where it is an "add-on" to an effective therapy or to evaluate exit-strategies of maintenance therapy after long-term deep remission. It has been, however, agreed that no child enrolled in a trial should receive a known inferior treatment both within and outside the trial. This also includes withholding therapy in children who show clinical response after a short induction therapy. Given the similarity between pediatric and adult IBD regarding pathophysiology and response to treatments, drugs generally cannot be considered being in genuine equipoise with placebo if it has proven efficacy in adults. Continued collaboration of all stakeholders is needed to facilitate drug development and evaluation in pediatric IBD.
authors.affiliation: *European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), Warsaw, Poland †European Crohn's and Colitis Organization (ECCO), Vienna, Austria ‡Global Pediatric IBD Network (PIBDnet) §Canadian Children IBD Network (a joint partnership of the Canadian Institutes of Health Research and the CH.I.L.D. Foundation), Toronto, ON, Canada ||Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel ¶Ludwig-Maximilians-University of Munich, Dr von Hauner Children's Hospital, University of Munich Medical Center-Klinikum der Universität München, München, Germany #The Hospital for Sick Children, University of Toronto, ON, Canada **Connecticut Children's Medical Center, Hartford ††Department of Pediatrics, Feinstein IBD Center, Icahn School of Medicine, Mount Sinai, New York, NY ‡‡Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands §§Department Neurofarba, University of Florence-Meyer Hospital, Florence |||| "La Sapienza" University of Rome, Rome, Italy ¶¶Department of Pediatrics, Children's Hospital Medical Center, University Hospitals, Bonn, Germany ##University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands ***Royal Hospital for Children, Glasgow, UK †††Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada ‡‡‡Children's University Hospital, Brussels §§§University Hospitals Gasthuisberg, Leuven, Belgium ||||||Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Dan
authors.initials: D
authors.lastname: Turner
authors.forename: Sibylle
authors.initials: S
authors.lastname: Koletzko
authors.forename: Anne M
authors.initials: AM
authors.lastname: Griffiths
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hyams
authors.forename: Marla
authors.initials: M
authors.lastname: Dubinsky
authors.forename: Lissy
authors.initials: L
authors.lastname: de Ridder
authors.forename: Johanna
authors.initials: J
authors.lastname: Escher
authors.forename: Paolo
authors.initials: P
authors.lastname: Lionetti
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lentze
authors.forename: Berthold
authors.initials: B
authors.lastname: Koletzko
authors.forename: Patrick
authors.initials: P
authors.lastname: van Rheenen
authors.forename: Richard K
authors.initials: RK
authors.lastname: Russell
authors.forename: David
authors.initials: D
authors.lastname: Mack
authors.forename: Gigi
authors.initials: G
authors.lastname: Veereman
authors.forename: Séverine
authors.initials: S
authors.lastname: Vermeire
authors.forename: Frank
authors.initials: F
authors.lastname: Ruemmele
mesh_terms: D002170:Canada; D002648:Child; D002986:Clinical Trials as Topic / Q000379:methods / Q000592:standards*; D032921:Consensus; D015507:Drugs, Investigational / Q000592:standards; D005060:Europe; D006805:Human Experimentation / Q000592:standards*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D010919:Placebos / Q000592:standards*; D012107:Research Design / Q000592:standards*; D057212:Therapeutic Equipoise
chemical_list: D015507:Drugs, Investigational; D010919:Placebos