There are ever-increasing therapeutic options for patients with ulcerative colitis (UC), but licensing and availability for children and young people are often years behind those aged >18 years. ‘Advanced therapies’, including biologics and small molecules, now target numerous different inflammatory pathways but continue to have a therapeutic ceiling with only 30–60% of patients responding to initial therapies, although with patients achieving mucosal healing having improved long-term outcomes. Within this review, we synthesise the paediatric evidence for the medicines, including anti-tumour necrosis factor, anti-integrin, anti-interleukin-12/23 monoclonal antibodies, alongside Janus kinase (JAK)-inhibitors and Sphingosine-1-phosphate inhibitors, used in moderate-to-severe UC, and extrapolate the adult literature where paediatric data are lacking. Finally, we look at the potential for optimal use and sequencing of these therapies when they are used in an empirical algorithm and consider some of the longer-term implications of loss of response.

中文翻译：

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患有中度至重度溃疡性结肠炎的儿童和青少年的治疗选择


溃疡性结肠炎 (UC) 患者的治疗选择不断增加，但儿童和青少年的许可和可用性往往落后于 18 岁以上的患者数年。包括生物制剂和小分子在内的“先进疗法”现在针对多种不同的炎症途径，但仍然存在治疗上限，只有 30-60% 的患者对初始疗法有反应，尽管患者实现粘膜愈合并改善了长期结果。在本次综述中，我们综合了这些药物的儿科证据，包括抗肿瘤坏死因子、抗整合素、抗白细胞介素 12/23 单克隆抗体，以及 Janus 激酶 (JAK) 抑制剂和 1-磷酸鞘氨醇抑制剂，用于中度至重度 UC，并推断缺乏儿科数据的成人文献。最后，我们研究了这些疗法在经验算法中使用时的最佳使用和排序的潜力，并考虑了反应丧失的一些长期影响。