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The incidence of inflammatory bowel diseases (IBDs), including Crohn’s disease (CD) and ulcerative colitis (UC), is increasing worldwide. Approximately 20% of cases present during childhood when the disease tends to be more aggressive and poses unique age-specific challenges. Children are likely to be exposed to many future years of toxic medical treatment but, by contrast, uncontrolled inflammation exposes the child to a lifetime risk of disease-associated complications, such as fibrosis, fistulas and cancer. Moreover, the early onset of the disease impacts on growth, bone health and puberty and carries emotional and social implications.
The introduction of biological therapies had a dramatic impact on treatment strategies in IBD. No longer do we settle for clinical improvement but strive for complete remission accompanied by mucosal healing. As a result, the new consensus European Crohn's and Colitis Organisation/ European Society of Pediatric Gastroenterology, Hepatology and Nutrition guidelines on managing paediatric CD recommend, for the first time, early use of biological therapy in selected high-risk children.
Proving effectiveness in randomised control trials (RCTs) is mandatory before introducing novel therapies. In children, the REACH and the T72 trials demonstrated the high effectiveness of infliximab in CD and UC, respectively, and the IMAgINE trial demonstrated similar effectiveness of adalimumab in paediatric CD. Golimumab and adalimumab are currently being evaluated in paediatric UC. However, only a small percentage of potentially eligible patients participate in RCTs, which usually do not mirror clinical practice and are of short-term duration. In light of these limitations, it would be wrong to underestimate the importance of studying real-life cohorts with long-term follow-up. We have previously summarised the long-term experience with infliximab in adults, showing that …
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