Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, South Korea.
Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu 41944, South Korea.
World J Gastroenterol. 2023 May 14;29(18):2784-2797. doi: 10.3748/wjg.v29.i18.2784.
Biologic agents with various mechanisms against Crohn's disease (CD) have been released and are widely used in clinical practice. However, two anti-tumor necrosis factor (TNF) agents, infliximab (IFX) and adalimumab (ADL), are the only biologic agents approved by the Food and Drug Administration for pediatric CD currently. Therefore, in pediatric CD, the choice of biologic agents should be made more carefully to achieve the therapeutic goal. There are currently no head-to-head trials of biologic agents in pediatric or adult CD. There is a lack of accumulated data for pediatric CD, which requires the extrapolation of adult data for the positioning of biologics in pediatric CD. From a pharmacokinetic point of view, IFX is more advantageous than ADL when the inflammatory burden is high, and ADL is expected to be advantageous over IFX in sustaining remission in the maintenance phase. Additionally, we reviewed the safety profile, immunogenicity, preference, and compliance between IFX and ADL and provide practical insights into the choice of anti-TNF therapy in pediatric CD. Careful evaluation of clinical indications and disease behavior is essential when prescribing anti-TNF agents. In addition, factors such as the efficacy of induction and maintenance of remission, safety profile, immunogenicity, patient preference, and compliance play an important role in evaluating and selecting treatment options.
生物制剂具有针对克罗恩病（CD）的多种作用机制，已广泛应用于临床实践中。然而，目前只有两种抗肿瘤坏死因子（TNF）药物，英夫利昔单抗（IFX）和阿达木单抗（ADL），被食品和药物管理局批准用于儿科 CD。因此，在儿科 CD 中，应更谨慎地选择生物制剂，以达到治疗目标。目前在儿科或成人 CD 中，尚无生物制剂的头对头试验。儿科 CD 的累积数据不足，需要从成人数据外推生物制剂在儿科 CD 中的定位。从药代动力学角度来看，在炎症负担较高时，IFX 比 ADL 更具优势，而在维持缓解期，ADL 有望优于 IFX。此外，我们还综述了 IFX 和 ADL 的安全性概况、免疫原性、偏好性和依从性，并为儿科 CD 中的抗 TNF 治疗选择提供了实用的见解。在开处方抗 TNF 药物时，必须仔细评估临床适应证和疾病行为。此外，诱导和维持缓解的疗效、安全性概况、免疫原性、患者偏好和依从性等因素在评估和选择治疗方案方面起着重要作用。
