Advanced therapies in management of pediatric inflammatory bowel disease

PURPOSE OF REVIEW: Pediatric inflammatory bowel disease (PIBD) has a rising global prevalence, with patients often demonstrating more aggressive and extensive disease activity compared to adult-onset disease. With improved access to therapeutic agents outside of the anti-TNF-α class, we seek to provide an updated framework for the management of PIBD patients through use of advanced biologic and small molecule therapies and to give guidance on the use of dual targeted therapy (DTT). RECENT FINDINGS: Although anti-TNF agents remain first-line options for moderate-to-severe Crohn's disease and ulcerative colitis, emerging pediatric clinical trial and real-world data support the use of vedolizumab and ustekinumab as second-line therapies. While PIBD-specific data are limited, novel anti-IL-23p19 agents and oral Janus kinase inhibitors (JAKi) have shown promising results for refractory disease. Emerging evidence supports the use of DTT for PIBD patients who do not achieve remission endpoints with use of a single agent. SUMMARY: Early aggressive intervention with advanced therapies leads to improved clinical outcomes in PIBD patients with moderate-to-severe disease activity. Proactive therapeutic drug monitoring (TDM) and strategic use of DTT allow for improved durability of therapy and better clinical remission rates. Additional pediatric studies are needed to properly position novel anti-IL-23p19 and JAKi agents.