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Edwin de Zoeten, Petar Mamula, What are the guidelines for using biologics in pediatric patients?, Inflammatory Bowel Diseases, Volume 14, Issue suppl_2, 1 October 2008, Pages S259–S261, https://doi.org/10.1002/ibd.20653
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The therapy of pediatric inflammatory bowel disease (IBD) focuses on the goals of symptom relief, appropriate growth, development, and good quality of life. Recently, mucosal healing has been added to this list of goals, which may have significant impact on the natural course of IBD and its complications. The development of biologic therapies has been a major advance in the attainment of these goals. As we further our understanding of the immunology of IBD, new biologic therapies continue to appear, including monoclonal antibodies targeted to inflammatory cytokines, adhesion, and surface molecules, as well as parasite-based therapy. With the development of these therapies we will need to define a logical approach to their use. Aside from infliximab and adalimumab, only limited data are available on other biologic agents. These other therapies are considered experimental and are available only through clinical trials.
The current approach to therapy of Crohn's disease (CD) and ulcerative colitis (UC) can be illustrated by the treatment pyramid or “step-up” approach, in which 5-aminosalicylic compounds and antibiotics and nutritional therapy in the case of CD form the base of the pyramid, and are used in the case of mild to moderate disease. As the illness moves toward a more severe disease, the therapy is escalated or “stepped-up” to include corticosteroids, while in the case of corticosteroid-dependent or -resistant disease immunomodulators such as 6-mercaptopurine and methotrexate are utilized. Finally, the use of biologic therapies and surgery is reserved for the tip of the management pyramid.
