Management of Paediatric Ulcerative Colitis, Part 1

Abstract

These guidelines provide a guide to clinicians managing children with UC and IBDU to provide modern management strategies while maintaining vigilance around appropriate outcomes and safety issues.

The impact of anti‐TNFα therapy on colectomy rates and corticosteroid treatment among 3001 paediatric and adolescent patients with ulcerative colitis—a nationwide study from 1995 to 2015

“…In paediatric and adolescent patients it is especially important to minimise the use of corticosteroids as corticosteroids may suppress growth even at low doses. 7,14,15 Our result on the use of corticosteroid in paediatric and adolescent patients treated with anti-TNFα therapy is not directly comparable to other studies. To our knowledge, only one study has investigated this issue after anti-TNFα treatment.…”

“…In patients who respond to anti‐TNFα therapy it is clinically important to consider whether the use of corticosteroid can be reduced or terminated. In paediatric and adolescent patients it is especially important to minimise the use of corticosteroids as corticosteroids may suppress growth even at low doses . Our result on the use of corticosteroid in paediatric and adolescent patients treated with anti‐TNFα therapy is not directly comparable to other studies.…”

“…6 The introduction of anti-TNFα has added a relevant treatment option for paediatric and adolescent patients with UC. 7,8 Cohort studies and randomised controlled trials have shown that anti-TNFα therapy can induce and maintain remission in paediatric patients, but the studies are limited by a follow-up length of maximum 2 years. [7][8][9][10] Previously published studies on the effect of anti-TNFα therapy and the risk of surgery are not consistent, but the risk of surgery has been suggested reduced.…”

“…7,8 Cohort studies and randomised controlled trials have shown that anti-TNFα therapy can induce and maintain remission in paediatric patients, but the studies are limited by a follow-up length of maximum 2 years. [7][8][9][10] Previously published studies on the effect of anti-TNFα therapy and the risk of surgery are not consistent, but the risk of surgery has been suggested reduced. 11,12 Following the initiation of anti-TNFα therapy, a corticosteroid-free remission proportion of 38% has been reported among 52 paediatric patients with UC during a 1-year follow-up.…”

“…7,8 The guidelines recommend a step-up approach encompassing 5-aminosalicylates (5-ASA), corticosteroids, immunomodulators, anti-TNFα therapy, and colectomy in patients not responding to the medical treatment. 7,8 However, an early introduction of anti-TNFα therapy is also discussed as a corticosteroid sparring therapy paying special attention and consideration to the growth and development of the child. 14,15 Our first results have indicated a decline in the colectomy risk after the introduction of anti-TNFα.…”