The Management of Paediatric Crohn’s Disease: Addressing Unmet Needs



Geneviève Veereman-Wauters1, *, Salvatore Cucchiara2
1 Division of Pediatric Gastroenterology, Hepatology and Nutrition, Queen Paola Children’s Hospital ZNA & University Hospital Antwerp, Belgium
2 Sapienza University of Rome, Pediatric Gastroenterology & Liver Unit, Center of Pediatric IBD, Italy


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© 2008 Veereman-Wauters and Cucchiara

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Queen Paola Children’s Hospital ZNA & University Hospital Antwerp, Belgium; Tel: +3232802101; Fax: +3232802133; E-mail: gigi.veereman@zna.be


Abstract

Paediatric Crohn’s disease (CD) affects 5 in 100,000 children in the US and Europe and can result in growth retardation and delayed sexual development. Therefore, early diagnosis and treatment is critical, with the goal being maintenance of symptomatic remission and a change in disease course. Conventional treatment relies on aminosalicylate maintenance therapy with corticosteroids to control acute exacerbations and immunomodulators for steroid-resistant or frequently relapsing disease. Infliximab has demonstrated efficacy in moderately to severely active paediatric CD, with 88.4% patients in clinical response and 58.9% in clinical remission at week 10. Significant improvements in quality of life, height, reduction in corticosteroid use and mucosal healing were observed with infliximab. Traditional ‘step-up’ treatment strategy may be suboptimal because relapse and steroid dependency/resistance rates remain high. A ‘top down’ approach using biologic therapy earlier may suppress intestinal inflammation and promote prolonged and stable remission, but safety issues need to be considered.