Antitumor necrosis factor treatment for pediatric inflammatory bowel disease

Abstract

Over the last 10 years, biologic treatment with the antitumor necrosis factor (anti-TNF) antibodies has dramatically changed the therapeutic approach in pediatric patients with inflammatory bowel disease (IBD). Currently, infliximab and adalimumab are the only anti-TNF drugs that have been approved for use in refractory pediatric Crohn’s disease (CD) and infliximab the only anti-TNF agent for use in refractory pediatric ulcerative colitis (UC). According to the current treatment recommendations, anti-TNF therapy is indicated for moderate and severe pediatric IBD when remission is not achieved using conventional treatment or conventional therapy is not tolerated by the patients. Despite the demonstrated efficacy of anti-TNF drugs in pediatric IBD patients, the potential development of serious adverse events, such as severe immune reactions, infections, and malignancies, limit the possibility of a wider use of anti-TNF drugs. Moreover, a substantial percentage of patients gradually develop non-responsiveness to these therapeutics, due to generation of antibodies against anti-TNF antibodies. Therefore, treatment of pediatric IBD patients with biologics should be undertaken in specialized tertiary medical centers, which are specially qualified for this purpose.