St Vincent's Hospital Clinical School, The University of Melbourne, Melbourne, Victoria, Australia.
Curr Opin Pediatr. 2012 Oct;24(5):609-14. doi: 10.1097/MOP.0b013e3283574154.
Therapeutic options and approaches in inflammatory bowel disease (IBD) continue to evolve. This review will summarize the recent studies of treatment strategies, efficacy, safety and outcome of biological agents in the treatment of children with Crohn's disease and ulcerative colitis.
Although there has been little recent change in the number of biologicals easily available for the treatment of children, usage has broadened in pediatric IBD and new treatment strategies have emerged. The use of biologicals in refractory pediatric ulcerative colitis is now accepted, with evidence supporting their potential for maintenance therapy. In pediatric Crohn's disease, scheduled treatment regimens have shown superiority to episodic treatment. Although the 'top-down' approach with early use of biologicals produces superior remission rates in adults, there is still little evidence in children. Concomitant immunosuppression appears to reduce immunogenicity and improve therapeutic control, but there are added risks for infection and malignancy.
Biologicals now form an integral part of the treatment algorithm in childhood IBD and their use is likely to increase. Treatment regimens, particularly those involving concomitant immunosuppressants, need to take account of the perceptions of risk.
炎症性肠病（IBD）的治疗选择和方法不断发展。本综述将总结生物制剂治疗儿童克罗恩病和溃疡性结肠炎的治疗策略、疗效、安全性和结局的最新研究。
尽管可用于治疗儿童的生物制剂数量变化不大，但在儿科 IBD 中的应用已扩大，并且出现了新的治疗策略。生物制剂在难治性儿童溃疡性结肠炎中的应用已被接受，有证据支持其用于维持治疗。在儿童克罗恩病中，计划治疗方案优于间歇性治疗。虽然在成人中早期使用生物制剂的“自上而下”方法可产生更高的缓解率，但在儿童中仍证据不足。同时使用免疫抑制剂似乎可降低免疫原性并改善治疗控制，但会增加感染和恶性肿瘤的风险。
生物制剂现在已成为儿童 IBD 治疗方案的重要组成部分，其使用可能会增加。治疗方案，特别是涉及同时使用免疫抑制剂的方案，需要考虑到风险认知。
