I think you are assuming things that were never said. Nobody is saying absolutely biologics for all children with UC, no matter what the doctor or parents think. We're talking clinical recommendation for moderate to severe cases is to go on biologics. If a parent believes absolutely under no situation can my child ever touch biologics, then of course that is the treatment course that will be taken (and nobody has said anything to the contrary within this thread). If a doctor believes a child is a very mild case and mesalamine-only treatment is the best course of action, then of course he/she will go down that route for him/her. All good doctors explain the risks versus benefits, listen to patient and parent concerns and work with them. And all good doctors base treatment courses based on patient symptoms and assess what is the appropriate and best treatment course to take with each patient, as nobody is
cookie-cutter the same lol.
Introducing biologics earlier in pediatric cases makes a lot of sense an recommending that seems like a good thing. I think bottom-up approach does not make much sense for moderate to severe pediatric cases. Top up does!
But I do not think scaring folks away from taking biologics is a good thing. Yes there is a risk of a lymphoma, and that risk is qualified as 4 in 10,000 or 0.04%. I wish that never happened to nobody, however, we are talking very small, remote odds that aren't the kind of thing to lose any sleep over. As the benefit far outweighs the risk. And, again, the lymphoma risk applies predominantly to immunomodulators (as everyone in the initial inflixmab/remicade study who got a lymphoma was also concurrently on thiopurines/immunomodulators like azathioprine/imuran/6mp).
So, if I was a parent of an adolescent male child, then I would start him/her on only the biologics with no immunomodulator, without hesitation if he presented a moderate to severe case. You might not, we're all individuals and do as we choose. All purely hypothetical as neither of us have to make that decision today
Post Edited (iPoop) : 1/30/2019 7:37:14 AM (GMT-7)