Redefining Therapeutic Approaches to Pediatric Ulcerative Colitis

Marla Dubinsky, MD, discusses what needs to be done to improve care for children with ulcerative colitis.

Early treatment for pediatric patients with ulcerative colitis and other gastrointestinal conditions is absolutely essential, argued Marla Dubinsky, MD, of Icahn School of Medicine at Mount Sinai.

In detailing the differences between ulcerative colitis in younger and older patients, Dubinsky noted that 8 out of 10 affected children present with pancolitis, or involvement of the entire colon. On the other hand, a significant majority of adult patients have rectal or left-sided inflammation.

“So, right off the bat, at presentation, children merit a more effective, early intervention approach because—by definition—they have a more diseased phenotype at the time of diagnosis” noted Dubinsky.

She explained a need to rethink the traditional scaling-up approaches to care, a practice especially utilized for pediatric populations. And so, it may be more effective to consider which patients merit early intervention with a biologic or anti-TNFs as first-line therapy.

Even more, she continued, biologics themselves should no longer be considered outside the bounds of what have long been defined as “conventional” therapies. After all, much of the conventional standard of treatment is currently off-label and carry risks that can and should not be ignored.

Dubinsky also explained the importance of having conversations surrounding safety with patients (and their guardians) and suggested how this conversation may evolve with new drugs, such as adalimumab, entering the playing field for pediatric ulcerative colitis.