Biological therapy in pediatric inflammatory bowel disease

Biological therapy has been used for many years in the treatment of inflammatory bowel disease; however, the primary and secondary ineffectiveness, the need to select the next line of therapy, requires more research, especially in the pediatric cohort.
Objective: the present study aims to investigate the features of switching biological therapy (BT) in pediatric practice.
Materials and Methods: in this retrospective prospective study, included cases of children with ulcerative colitis and Crohn’s disease between 2018 and 2023. Demographic and clinical features of the disease, reasons for prescribing and switching BT, and 1st-line survival were studied. The efficacy of therapy was evaluated based on activity indices: PUCAI/ PCDAI, UCEIS/ SES-CD, IBD-DCA. Height-weight indices were evaluated using the standard deviation coefficient. Laboratory evaluation of a set of indices of general and biochemical blood tests were performed.
Results: out of 163 patients with IBD, 70 (43.9%) were receiving BT, the 1st line therapy groups included 42 (60%) with CD (group 1) and 17 (24.3%) with UC (group 2), the 2nd line groups included 7 (10%) with CD (group 3) and 4 (5.7%) with UC (group 4). There were no significant differences in clinical, endoscopic and morphologic activity levels between the groups. Lesion extent was significantly greater in the switching groups. The most frequent extraintestinal manifestation (EIM) was joint syndrome 51.4%. In 1st group, the leading reason for BT prescription 19 (45.2%) was the presence of EIM, and in the 2nd group, steroid dependence 8 (47.1%). The 1-line BT survival was 43.57 (30.21) months and 57.00 (54.00) months in 3d and 4th groups, respectively.
Conclusions: a high frequency of steroid dependence, steroid resistance and EIM was revealed, which entailed early prescription of BT. Given the peculiarities of the clinical picture and ineffectiveness of 1st-line BT in our cohort, a wide range of biologic agents were used off-label.

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