Infliximab Therapy for Pediatric Crohn Disease and Ulcerative Colitis

The inflammatory bowel diseases (IBDs), including Crohn disease and ulcerative colitis, are chronic inflammatory disorders of the gastrointestinal tract most often diagnosed in adolescence and young adulthood, with a rising incidence in the younger (<10 years old) pediatric population. The goals of therapy of IBD in children consist of eliminating gastrointestinal symptoms, normalizing quality of life, restoring growth, and preventing complications while minimizing the adverse effects of medications. These goals are often not achieved with previous therapeutic strategies (corticosteroids, 5-aminosalicylates, and immunomodulators), with use of biologics (such as anti-TNF agents), increasingly prescribed as first-line therapy for Crohn disease and a second-line option for ulcerative colitis. Infliximab was the first anti-TNF agent to be approved for treatment of IBD. Anti-TNF use, however, must be tempered with recognition of potential side effects and a high yearly loss of response. Emerging strategies to minimize loss of response with an optimized dosing approach guided by therapeutic drug monitoring are being employed to maintain long-term remission with these medications.