A severe clinical phenotype along with concern for ensuring normal growth and development has a major impact on treatment choices for children newly diagnosed with Crohn's disease (CD).
We review the increasingly outdated concept of 'conventional' therapy of pediatric CD based on aminosalicylates, corticosteroids, and immunomodulators for patients at high risk of complicated disease. Key safety concerns with each treatment are reviewed.
There are minimal data supporting the use of aminosalicylates in the treatment of pediatric CD. Corticosteroids are effective short-term for improving signs and symptoms of disease but are ineffective for maintenance therapy. Thiopurines decrease corticosteroid dependence but may not alter progression to complicated disease requiring surgery. Concerns for lymphoma as well as hemophagocytic lymphohistiocytosis with thiopurines are valid. Further data are required on the efficacy and safety of methotrexate as an alternative immunomodulator. Though generally well tolerated and efficacious in most patients, anti-TNF-α therapy can be associated with both mild as well as more serious complications. Current data do not support an increased risk for malignancy associated with anti-TNF therapy alone in children. Anti-adhesion therapy appears to have a favorable safety profile but the experience in children is extremely limited.