Pharmacol Res. 2023 Sep 23:196:106935. doi: 10.1016/j.phrs.2023.106935.Online ahead of print.

Francesca Penagini ¹, Luisa Lonoce ², Luisa Abbattista ², Valentina Silvera ², Giulia Rendo ², Lucia Cococcioni ², Dario Dilillo ², Valeria Calcaterra ³, Gian Vincenzo Zuccotti ⁴

Author information

¹Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy. Electronic address: Francesca.penagini@asst-fbf-sacco.it.

²Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy.

³Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy; Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.

⁴Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy; Department of Biomedical and Clinical Science "L. Sacco", University of Milano, Milano, Italy.

Abstract

Inflammatory bowel diseases (IBDs) including Crohn's disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBD-U) are chronic inflammatory disorders which can affect the gastrointestinal tract. Anti-tumor necrosis factors antibodies (anti-TNFα) such as infliximab (IFX) and adalimumab (ADA) are the first line biological therapy for severe or complicated IBDs in pediatric age. Second line therapeutic options as vedolizumab (VDZ) and ustekinumab (UST) are currently used off-label in pediatric age. Furthermore, despite optimization of biologics, a great proportion of patients may fail to respond to biologic agents (up to 30%) or lose response over the time (around 50%) hence these patients may be left without another valid therapeutic option. Consequently, several efforts have been made in the last years in order to develop new drugs and to contrive new therapeutic strategies. Small molecule drugs (SMDs) and combination therapy with either two biologic agents or with a SMD and a biological agent have recently been proposed. Data on safety and efficacy of these new therapeutic options are limited. The objective of the present review is to summarize the most up-to-date available literature in pediatric IBD.