Expert Rev Gastroenterol Hepatol. 2022 Nov-Dec;16(11-12):1023-1028.doi: 10.1080/17474124.2022.2149489. Epub 2022 Nov 21.

Bénédicte Pigneur ^1 2 3, Frank M Ruemmele ^1 3 4

Author information

¹Service de Gastro-entérologie et Nutrition pédiatrique, Centre de Référence des Maladies rares digestives (MARDI), Assistance Publique - Hôpitaux de Paris, Hôpital Necker Enfants malades, Paris, France.

²INSERM UMR S 1139, Faculté de Pharmacie de Paris, Paris, France.

³Faculté de Médecine, Université de Paris Cite, Paris, France.

⁴INSERM UMR 1163, Immunité intestinale, Institut Imagine, Paris, France.

Abstract

Introduction: Anti-tumor necrosis factor (TNF) antibodies play a major role in treating inflammatory bowel disease (IBD), both in adult and pediatric patients. While there is a large number of studies on efficacy and safety of infliximab in treating children and adolescents with ulcerative colitis (UC), data on adalimumab (ADA) are scarce.

Areas covered: Here, we review published case reports, cohort and real-time data, as well as the first randomized trial, ENVISION I, using ADA for treating pediatric UC. Available evidence confirms good efficacy in inducing and maintaining remission in children and adolescents with UC, with even higher response rates compared to adult UC. ENVISION I showed that in UC patients responding to ADA induction therapy, almost half of the patients remained in remission after 52 weeks of therapy on high-dosing ADA (weekly administration). As already well experienced with other biologics, dosing schemes are different between pediatric and adult patients, with children often requiring higher dosing.

Expert opinion: Further data are required to better understand how to optimize ADA therapy. The present and still-growing evidence places subcutaneous (sc.) anti-TNF-medication as alternative first-line therapy also for pediatric UC. This is also reflected by the preference for sc. medication of adolescent patients allowing less frequent and autonomous drug administration.