Therapeutic options for children and young people with moderate-to-severe ulcerative colitis

There are ever-increasing therapeutic options for patients with ulcerative colitis (UC), but licensing and availability for children and young people are often years behind those aged >18 years. ‘Advanced therapies’, including biologics and small molecules, now target numerous different inflammatory pathways but continue to have a therapeutic ceiling with only 30–60% of patients responding to initial therapies, although with patients achieving mucosal healing having improved long-term outcomes. Within this review, we synthesise the paediatric evidence for the medicines, including anti-tumour necrosis factor, anti-integrin, anti-interleukin-12/23 monoclonal antibodies, alongside Janus kinase (JAK)-inhibitors and Sphingosine-1-phosphate inhibitors, used in moderate-to-severe UC, and extrapolate the adult literature where paediatric data are lacking. Finally, we look at the potential for optimal use and sequencing of these therapies when they are used in an empirical algorithm and consider some of the longer-term implications of loss of response.