title: The safety of treatment options for pediatric Crohn's disease.
abstract: BACKGROUND
  A severe clinical phenotype along with concern for ensuring normal growth and development has a major impact on treatment choices for children newly diagnosed with Crohn's disease (CD).
  
  
  METHODS
  We review the increasingly outdated concept of 'conventional' therapy of pediatric CD based on aminosalicylates, corticosteroids, and immunomodulators for patients at high risk of complicated disease. Key safety concerns with each treatment are reviewed.
  
  
  CONCLUSIONS
  There are minimal data supporting the use of aminosalicylates in the treatment of pediatric CD. Corticosteroids are effective short-term for improving signs and symptoms of disease but are ineffective for maintenance therapy. Thiopurines decrease corticosteroid dependence but may not alter progression to complicated disease requiring surgery. Concerns for lymphoma as well as hemophagocytic lymphohistiocytosis with thiopurines are valid. Further data are required on the efficacy and safety of methotrexate as an alternative immunomodulator. Though generally well tolerated and efficacious in most patients, anti-TNF-α therapy can be associated with both mild as well as more serious complications. Current data do not support an increased risk for malignancy associated with anti-TNF therapy alone in children. Anti-adhesion therapy appears to have a favorable safety profile but the experience in children is extremely limited.
authors.affiliation: a Division of Digestive Diseases, Hepatology, and Nutrition , Connecticut Children's Medical Center , Hartford , CT , USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Grossi
authors.affiliation: a Division of Digestive Diseases, Hepatology, and Nutrition , Connecticut Children's Medical Center , Hartford , CT , USA.|b University of Connecticut School of Medicine , Farmington , CT , USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hyams
mesh_terms: D000636:Aminosalicylic Acids / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy* / Q000503:physiopathology; D018450:Disease Progression; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000636:Aminosalicylic Acids; D005938:Glucocorticoids; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate
keywords: Crohn’s; Thiopurines; children; infliximab