Biologics in pediatric Crohn's disease: is it time to move to an earlier therapeutic approach?

The treatment of Crohn's disease in children has undergone a revolution in the past decade following studies that have demonstrated the efficacy of anti-TNF alpha agents in producing durable clinical response/remission as well as reversal of growth delay in many patients. The positioning of biologic therapy continues to be debated. Should it be reserved for children failing conventional therapy including immunomodulators or should it be used as primary therapy shortly after diagnosis in children with more severe disease likely to suffer a more complicated disease course? Risk stratification will be crucial to any therapeutic decisions and emerging data hold promise that identification of those most likely to benefit will be available in the near future.