Batra Suruchi, Conklin Laurie S
Division of Gastroenterology, Hepatology, and Nutrition, Children's National Medical Center, Washington, DC, USA.
George Washington University School of Medicine, Children's National Medical Center, Washington, DC, USA.
Handb Exp Pharmacol. 2020;261:363-375. doi: 10.1007/164_2019_255.
Pharmacologic treatment of children and adolescents with inflammatory bowel diseases (IBD) [Crohn's disease and ulcerative colitis] requires consideration of disease and medication effects on growth and nutrition, the importance of durability of biologics, and concerns for long-term sequelae of disease and therapies. Achieving early remission in children with Crohn's disease correlates with improved outcomes and therefore allows a window of opportunity for maximizing growth. Thus, there is a great need to treat children and adolescents with the right drug at the right time while achieving adequate exposure. Improved understanding of disease phenotypes, disease natural history, and risk stratification will play a critical role in treatment selection for children, particularly as more therapeutic options become available. Here we summarize data supporting newer concepts of treating the individual child with IBD through targeted early biologic treatment, including utilization of therapeutic drug monitoring to optimize treatment effects and the use of early antitumor necrosis factor (TNF)-α therapies to mitigate long-term sequelae of the disease. Recent inception cohort studies provide important data regarding the risk stratification of children and adolescents with IBD, which support a move toward a personalized therapeutic approach to IBD in children and adolescents.
对患有炎症性肠病（IBD）[克罗恩病和溃疡性结肠炎]的儿童和青少年进行药物治疗，需要考虑疾病和药物对生长及营养的影响、生物制剂疗效的持久性，以及对疾病和治疗长期后遗症的担忧。使克罗恩病患儿早期缓解与改善预后相关，因此为实现生长最大化提供了一个机会窗口。因此，非常有必要在合适的时间用合适的药物治疗儿童和青少年，同时实现足够的药物暴露。对疾病表型、疾病自然史和风险分层的更好理解将在儿童治疗选择中发挥关键作用，尤其是随着更多治疗选择的出现。在此，我们总结支持通过有针对性的早期生物治疗来治疗患有IBD的个体儿童的最新概念的数据，包括利用治疗药物监测来优化治疗效果，以及使用早期抗肿瘤坏死因子（TNF）-α疗法来减轻疾病的长期后遗症。最近的起始队列研究提供了关于患有IBD的儿童和青少年风险分层的重要数据，这支持了朝着对儿童和青少年IBD采用个性化治疗方法的转变。
