Special considerations for biologic medications in pediatric ulcerative colitis

ABSTRACT

Introduction: More extensive disease, high rates of corticosteroid refractory and dependent disease, and the potential impact of disease on growth and development differentiate inflammatory bowel disease in children from adults. This is particularly evident in ulcerative colitis where pancolitis predominates, success of mesalamine alone in achieving remission is less than 50%, and there is a high need for immunomodulator or biologic therapies.

Areas Covered: This review describes the use of infliximab, adalimumab, golimumab, and vedolizumab in the treatment of children with ulcerative colitis but is limited in scope due to the paucity of controlled clinical trials. A search of existing literature with keywords of these specific biological therapies as well as ‘pediatric’, ‘ulcerative colitis,’ and ‘inflammatory bowel disease’ was used to complete this review.

Expert Opinion: Therapeutic drug monitoring has become standard of care when assessing dosing and changes in therapy and will play a role in future treatment planning.

KEYWORDS:

• Adalimumab
• biologic
• golimumab
• infliximab
• Inflammatory Bowel Disease (IBD)
• ulcerative colitis
• vedolizumab
• children

Article Highlights

• Several biologic therapies are currently used in the treatment of pediatric-onset ulcerative colitis despite the lack of FDA approved medications for this age group with the exception of infliximab.

• Infliximab has significant evidence guiding its use as a treatment for pediatric ulcerative colitis in comparison to other biologic medications.

• Higher doses and more frequent administration of infliximab may be beneficial in treatment of corticosteroid-refractory acute severe ulcerative colitis.

• Therapeutic drug monitoring has more recently become a tool to guide biologic therapy dosing, although optimal drug levels continue to be an area of research.

This box summarizes key points contained in the article.

Declaration of interest

J Hyams is on Advisory Boards for Janssen and Abbvie, and acts as a consultant for Pfizer, Lilly, Boehringer Ingelheim, Allergan, Roche and Celgene. 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.

Reviewer Disclosures

One of the reviewers on this manuscript acts as a moderator, speaker and advisory board member for Janssen and Abbvie. Other peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.