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• W4387357252 abstract "ABSTRACTIntroduction Children and adolescents with Crohn’s disease present unique challenges due to extensive disease at diagnosis and the effect of bowel inflammation on growth. Historical approaches with corticosteroids and immunomodulators are far less effective than early treatment with anti-TNF biologics.Areas covered This review covers recent literature delineating the crucial role of early anti-TNF therapy in the treatment of moderate- to- severe Crohn’s disease in children and adolescents. The potential risks and benefits of concomitant immunomodulators is discussed, along with therapeutic anti-TNF drug monitoring, and reassessment by endoscopy and cross-sectional imaging to evaluate success beyond symptoms control.Expert opinion Standard of care therapy for moderate-to-severe pediatric Crohn’s disease now entails precision dosing of anti-TNF therapy with periodic reassessment of bowel inflammation. The role of dietary modification continues to evolve. Current and future efforts need to be directed to elucidating ways to predict response to anti-TNF therapy and quickly changing to agents with other mechanisms of action when needed. Inordinate regulatory delays in approval of new therapies approved for adults continues to handicap pediatric clinicians and frequently limits their treatment choices, or forces them to give medications ‘off label.’ Only a concerted effort by clinicians, pharma, and regulators will improve this situation.KEYWORDS: Anti-TNFbiologic therapychildreninflammatory bowel diseaseDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Declaration of interestJS Hyams is on the Advisory board Janssen, Abbvie, Pfizer, BMS, Lilly, consultant Takeda, Boehringer-Ingelheim. 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Author contributionsK Baldwin and V Grossi contributed equally to this paper.Article highlightsEarly positioning of biologic therapies is key to ensuring treatment goals are metOptimize the first biologic therapy with therapeutic drug monitoring, combination therapy with an immunomodulator, or both in the appropriate contextGoal of treatment has shifted to mucosal and transmural healing, and monitoring should reflect this to prevent complications and optimize growth and developmentFigure 1. Terminal ileal ulcerationDisplay full sizeFigure 2. Magnetic resonance enterography demonstrating long-segment thickened dilated terminal ileal to ileocecal valveDisplay full sizeAdditional informationFundingThis paper was not funded." @default.
• W4387357252 created "2023-10-06" @default.
• W4387357252 creator A5006726610 @default.
• W4387357252 creator A5007866860 @default.
• W4387357252 creator A5044683327 @default.
• W4387357252 date "2023-10-04" @default.
• W4387357252 modified "2023-10-06" @default.
• W4387357252 title "Managing pediatric Crohn’s disease: recent insights" @default.
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