Loss of response to biologics versus increased risk of lymphoma in children with inflammatory bowel disease: the clinician’s conundrum

Abstract

Inflammatory bowel disease in children can be marked by aggressive disease both at presentation and over time. Risk stratification of individual patients may help identify when early biologic therapy is justified. Currently, combination biologic and immunomodulator therapy for moderate-to-severe Crohn’s disease is the most effective treatment regimen. The clinician’s conundrum arises from the recent understanding that rare but serious adverse events do occur with use of these strong immune suppressive drugs and may be more prevalent with combination therapy. An understanding of the natural history of Crohn’s disease and ulcerative colitis and the benefits and risks of the current medical armamentarium is essential to provide optimal care for each child with inflammatory bowel disease.

Keywords::

• 6-mercaptopurine
• anti-tumor necrosis factor
• antibodies to infliximab
• azathioprine
• children
• Crohn’s disease
• immunomodulators
• inflammatory bowel disease
• infliximab
• loss of response
• lymphoma
• methotrexate
• pediatric
• ulcerative colitis

Financial & competing interests disclosure

A Bousvaros is a consultant for Millennium, has received research support and honorarium from Merck Pharmaceuticals, a research grant from Prometheus labs, research support from UCB, and is on the Advisory Board for Dyax. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.