Increased Effectiveness of Early Therapy With Anti-Tumor Necrosis Factor-α vs an Immunomodulator in Children With Crohn's Disease

Pediatric Crohn disease patients exhibit specific ileal transcriptome and microbiome signature

“…This is especially relevant now, when second-line biologic medications are on track for approval (9,10) by the FDA, and there is an ongoing need to identify patients that will derive the greatest relative benefit from early biological therapy with anti-TNF-α agents (8,11). A recent comparative effectiveness study that used the same inception cohort as the current report showed that early anti-TNF-α therapy is superior to other approaches in achieving 1-year steroid-and surgery-free remission (SSFR) (11). No clinical or demographic parameters were specifically associated with therapeutic response, suggesting that additional information is needed to better define patient subsets.…”

Disease Status and Pubertal Stage Predict Improved Growth in Antitumor Necrosis Factor Therapy for Pediatric Inflammatory Bowel Disease

“…Further evidence is provided by another prospective multicentre North American study that observed improved growth and clinical outcome at 12 months of those treated with early IFX (within 3 months of diagnosis) compared with early immunomodulator therapy or no therapy 39 . The reason for improved growth in those with a longer disease course in our cohort could be that the growth and/or pubertal development has been impaired for a prolonged period due to the cytokine-driven inflammatory process but when the inflammation is 'switched off' with anti-TNF therapy, improved growth is then seen.…”

Biologics in pediatric Crohn’s disease: is it time to move to an earlier therapeutic approach?

“…More recently, a study of newly diagnosed children with Crohn's disease has provided the first 'real-life' attempt at comparative effectiveness of early therapy with anti-TNFa compared to traditional immunomodulator-based early therapy with subsequent step-up to anti-TNFa if needed [13]. Using propensity scoring methodology to carefully match early antiTNFa-exposed children (<3 months from diagnosis) to those receiving early immunomodulator only or those receiving no early immunosuppression, striking differences at 1 year were noted.…”