Pediatric ulcerative colitis: current treatment approaches including role of infliximab

Figures & data

Table 1 Classes of medications used in the management of pediatric ulcerative colitis

Medication class	Clinical indications	Common side effects
5-aminosalicylates	Mild-to-moderate disease	Headaches, nausea, diarrhea, photosensitivity
Corticosteroids	Acute moderate-to-severe disease	Hyperglycemia, hypertension, growth failure, weight gain, osteopenia, mood disturbances
Thiopurine immunomodulators	Maintenance of remission of moderate-to-severe disease	Bone marrow suppression, hepatitis, pancreatitis, infections, malaise, rashes
Calcineurin inhibitors	Acute severe or fulminant disease	Nephrotoxicity, infections, seizures, hirsutism, hypertension, headaches
Antibiotics	Adjunctive therapy for active disease; pouchitis	Specific to individual antibiotics
Probiotics	Adjunctive therapy for active disease; recurrent pouchitis	Limited data
Anti-TNF-α agents	Induction and maintenance of remission of moderate-to- severe disease	Hypersensitivity reactions, headaches, nausea, abdominal pain, infections

Abbreviation: TNF-α, tumor necrosis factor-α.

Table 2 Case series reporting the use of infliximab in the treatment of pediatric ulcerative colitis

Authors	Study population	Outcomes measured	Conclusions
Mamula et al^Citation35	9 children	Clinical response (LCAI, PGA) at 2 days and 2 weeks	Median LCAI score decreased from 11 before infusion to 1 at 2 days and 2 weeks after infusion; decreased disease activity in 7 patients by PGA
Mamula et al^Citation36	17 children	Avoidance of colectomy or escalation of medical therapy	14 patients with short-term response; 10 of 16 patients with sustained response (>9 months)
Russell and Katz^Citation37	14 children	Clinical response (LCAI) by week 6	9 patients with sustained decrease of LCAI to ≤2
Eidelwein et al^Citation38	12 children	Clinical response (PGA)	9 patients with complete short-term response at 2 weeks, 3 with partial response; 8 patients with long-term response at 6 months
Fanjiang et al^Citation39	27 children	Clinical response (LCAI); avoidance of colectomy and CSs	Successful treatment in 75% of acutely ill and 27% of chronically ill patients; mean follow-up 27 months
Cucchiara et al^Citation40	22 children	Clinical response (LCAI) by week 54	12 responders, 6 partial responders, 4 nonresponders; 7 patients required colectomy
McGinnis and Murray^Citation41	40 children	Clinical response (Truelove and Witts criteria)	28 responders, median follow-up 19 months
Hyams et al^Citation44	52 children	Clinical response (PGA)	CS-free inactive disease in 26%, 27%, 38%, and 21% of patients at 3, 6, 12, and 24 months
Tiemi et al^Citation42	21 children (7 UC, 14 CD)	Clinical response (clinical manifestations, disease activity indices, CS use) by week 22	18 patients in remission, 3 patients with clinical improvement; significant improvement in disease activity indices; 6 of 15 patients discontinued CSs
Hyams et al^Citation43	60 children	Clinical response (disease activity indices) by week 8	44 responders

Abbreviations: LCAI, Lichtiger colitis activity index; PGA, physician global assessment; CS, corticosteroid; UC, ulcerative colitis; CD, Crohn’s disease.

MamulaPMarkowitzJEBrownKAHurdLBPiccoliDABaldassanoRNInfliximab as a novel therapy for pediatric ulcerative colitisJ Pediatr Gastroenterol Nutr200234330731111964959

 PubMed Web of Science ®Google Scholar

MamulaPMarkowitzJECohenLJvon AllmenDBaldassanoRNInfliximab in pediatric ulcerative colitis: two-year follow-upJ Pediatr Gastroenterol Nutr200438329830115076630

 PubMed Web of Science ®Google Scholar

RussellGHKatzAJInfliximab is effective in acute but not chronic childhood ulcerative colitisJ Pediatr Gastroenterol Nutr200439216617015269622

 PubMed Web of Science ®Google Scholar

EidelweinAPCuffariCAbadomVOliva-HemkerMInfliximab efficacy in pediatric ulcerative colitisInflamm Bowel Dis200511321321815735427

 PubMed Web of Science ®Google Scholar

FanjiangGRussellGHKatzAJShort- and long-term response to and weaning from infliximab therapy in pediatric ulcerative colitisJ Pediatr Gastroenterol Nutr200744331231717325550

 PubMed Web of Science ®Google Scholar

CucchiaraSRomeoEViolaFInfliximab for pediatric ulcerative colitis: a retrospective Italian multicenter studyDig Liver Dis200840Suppl 2S260S26418598998

 PubMedGoogle Scholar

McGinnisJKMurrayKFInfliximab for ulcerative colitis in children and adolescentsJ Clin Gastroenterol200842887587918645529

 PubMed Web of Science ®Google Scholar

HyamsJSLererTGriffithsAOutcome following infliximab therapy in children with ulcerative colitisAm J Gastroenterol201010561430143620104217

 PubMed Web of Science ®Google Scholar

TiemiJKomatiSSdepanianVLEffectiveness of infliximab in Brazilian children and adolescents with Crohn disease and ulcerative colitis according to clinical manifestations, activity indices of inflammatory bowel disease, and corticosteroid useJ Pediatr Gastroenterol Nutr201050662863320386321

 PubMed Web of Science ®Google Scholar

HyamsJDamarajuLBlankMInduction and maintenance therapy with infliximab for children with moderate to severe ulcerative colitisClin Gastroenterol Hepatol201210439139922155755

 PubMed Web of Science ®Google Scholar