Editorial: Distinct Challenges of Paediatric From Adult-Onset Inflammatory Bowel Disease, Implications of Aggressive Disease Phenotypes and Early Biologic Therapy in Children

Abstract

The rising incidence of paediatric inflammatory bowel disease (PIBD) poses increasing challenges in its management [1]. Previous population-based studies demonstrated that IBD in children typically manifests with a more severe phenotype compared with adults [2]. This adversely affects quality of life through factors such as hospitalisation, poor growth, limitations in daily activities and school absenteeism [3]. Despite the recent approval of several new therapeutic options for adult IBD and the increasingly early use of biologics in children, only one advanced therapeutic class is currently approved for PIBD [4].

Using a large, registry-based cohort with extended follow-up, Granot et al. reported significant differences in disease characteristics and treatment exposure between paediatric- and adult-onset IBD [5]. The authors emphasised the more extensive disease at onset in PIBD compared with adult-onset IBD. They also highlighted the greater exposure to immunomodulators and biologic therapies, as well as the higher need for treatment intensification in children, among both Crohn's disease and ulcerative colitis. Furthermore, biologic agents and JAK inhibitors were significantly more utilised as both first- and second-line therapies in children compared with adults.

This study, which included patients diagnosed between 2000 and 2022, provides valuable insights into the evolving therapeutic landscape for PIBD and how the use of biologics has evolved. Notably, the authors highlighted a clear trend towards the earlier initiation of biologics in both paediatric and adult populations, reflecting the increasing emphasis on innovative, targeted therapies. These findings are consistent with recent recommendations supporting a top-down or intensified step-up approach to PIBD management, wherein biologics are introduced early in the disease course, particularly in moderate-to-severe cases, to prevent long-term complications and improve outcomes [6-8].

However, despite these advances, huge challenges remain in the management of PIBD. The approval process for new biologics lags in the paediatric setting, with many therapies becoming available for children over 8 years after their approval for adult use [4]. Recent guidelines from the European Crohn's and Colitis Organization state that treatment selection should be based on the merits of the drug rather than following a traditional stepwise progression from conventional to advanced therapies [9]. This underscores the urgent need to streamline the approval process for new biologics in PIBD. Early access to these treatments is crucial, since children with IBD, even more than adults, will require long-term or lifelong management to control their disease, to facilitate development of skills like their peers, maintain a good quality of life and fully participate in society.

In conclusion, Granot and colleagues underscored the unique challenges of managing paediatric-onset IBD and the critical role of novel drug therapies in addressing the more extensive and aggressive disease course often seen in these patients. Moving forward, it is imperative to leverage real-world data from paediatric populations to gain insights that can accelerate and remodel the regulatory pathway for biologics in paediatric practice, ensuring timely and safe treatment for children with IBD.

Alessandro Molinaro: writing – original draft, writing – review and editing. Lissy de Ridder: writing – original draft, writing – review and editing.

This article is linked to Granot et al papers. To view these articles, visit https://doi.org/10.1111/apt.18264 and https://doi.org/10.1111/apt.18310.