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

Paediatric Crohn's disease (CD) affects 5 in 100,000 children in the US and Europe and can result in growth re- tardation and delayed sexual development. Therefore, early diagnosis and treatment is critical, with the goal being main- tenance of symptomatic remission and a change in disease course. Conventional treatment relies on aminosalicylate main- tenance therapy with corticosteroids to control acute exacerbations and immunomodulators for steroid-resistant or fre- quently 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 remis- sion, but safety issues need to be considered.