TNF inhibitors as a treatment of pediatric IBD

Abstract

TNF inhibitors were the pioneering biologic agents utilized in the management of inflammatory bowel disease (IBD), with some undergoing clinical trials in pediatric populations and approved for use in children. The advent of TNF inhibitors has markedly transformed the treatment landscape for pediatric IBD, demonstrating efficacy not only in ameliorating clinical symptoms but also in addressing growth impairment and other manifestations. In Crohn's disease, treatment guidelines and international recommendations advocate for the precedence of TNF inhibitors over alternative biologic agents. In ulcerative colitis, European guidelines prioritize infliximab, while Japanese protocols encompass a spectrum of biologics and small molecules beyond TNF inhibitors for refractory cases, necessitating personalized treatment decisions accounting for variables such as administration route and onset of efficacy alongside pediatric indications. Internationally, combining infliximab with immunomodulatory agents is advised to mitigate anti-drug antibody formation, typically recommended within approximately 6 months following the initiation of infliximab therapy. Furthermore, caution should be exercised regarding potential dose escalation requirements for TNF agents relative to adult dosing.