Precision dosing and personalized medicine in pediatric inflammatory bowel disease

Children with inflammatory bowel disease (IBD) have a chronic progressive gastrointestinal illness with significant morbidity and disease complications if not adequately treated. As treatments are often not extensively studied in children and there is a significant delay in regulatory approval for the pediatric age, there are limited treatment options available for children with IBD. This thesis sought to identify strategies to best utilize current IBD treatments for children to prolong durability and optimize treatment outcomes.
Part I of this thesis addressed several important questions about when and how to best implement immunomodulators for pediatric IBD, including both those used as monotherapy as well as those used in combination therapy with more emerging therapies. Furthermore, conventional dosing of more novel biologic therapies is often inadequate for children and there is a wide variability in how children respond to different doses. Thus, Part II of this thesis further investigated how to best personalize dosing for several biologic therapies to account for conventional clinical variables as well as microbial and genetic targets.