Academic Journal
Risks of Undertreatment and Overtreatment in Pediatric Inflammatory Bowel Disease: Navigating the Balance.
| Τίτλος: | Risks of Undertreatment and Overtreatment in Pediatric Inflammatory Bowel Disease: Navigating the Balance. |
|---|---|
| Συγγραφείς: | D'Arcangelo G; Gastroenterology, Hepatology and Cystic Fibrosis Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy., Ancona S; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy., Naspi Catassi G; Gastroenterology, Hepatology and Cystic Fibrosis Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy., Musto F; Gastroenterology, Hepatology and Cystic Fibrosis Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy., Celano R; Gastroenterology, Hepatology and Cystic Fibrosis Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy., Aloi M; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. marina.aloi@unimi.it.; Gastroenterology, Hepatology and Cystic Fibrosis Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy. marina.aloi@unimi.it. |
| Πηγή: | Paediatric drugs [Paediatr Drugs] 2026 Jul; Vol. 28 (4), pp. 331-342. Date of Electronic Publication: 2026 Jun 11. |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer International Country of Publication: Switzerland NLM ID: 100883685 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1179-2019 (Electronic) Linking ISSN: 11745878 NLM ISO Abbreviation: Paediatr Drugs Subsets: MEDLINE |
| Imprint Name(s): | Publication: June 2010- : Cham, Switzerland : Springer International Original Publication: Auckland ; Philadelphia : Adis International, c1999- |
| Ιατρικοί όροι (MeSH): | Inflammatory Bowel Diseases*/drug therapy , Overtreatment*, Immunosuppressive Agents/therapeutic use ; Humans ; Child ; Undertreatment ; Adolescent |
| Περίληψη: | Despite major therapeutic advances in recent years, and early signs that the overall standard of care we can deliver to children with inflammatory bowel disease (IBD) is improving, the promise of precision medicine remains largely unfulfilled in daily practice. The goal is to match the right therapy to the right patient, in the right time window, so that treatment intensity reflects true disease biology and future risk rather than broad population averages. However, this approach is still an unmet need. Even when management is framed within a risk-based paradigm, clinical decisions are often guided by generalized recommendations and imperfect predictors, with limited capacity to individualize strategies at diagnosis and during follow-up. As a result, two opposite but equally relevant pitfalls remain very real. On one hand, overtreatment can lead to unnecessary exposure to immunosuppressive regimens in children and adolescents with mild, slowly progressive, or self-limited disease, increasing the burden of adverse events, monitoring, and psychosocial impact. On the other hand, undertreatment in truly high-risk patients can delay effective control of inflammation, allowing ongoing tissue damage, disease extension, growth impairment, and avoidable complications, ultimately worsening long-term outcomes. This critical review summarizes and critically appraises current recommendations and available evidence, focusing on the pitfalls of overtreatment and undertreatment in pediatric IBD. (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Data availability: Not applicable. Funding: No honorarium, grant, or other form of payment was given to anyone to write and produce the manuscript. Conflict of Interest: Marina Aloi is an Editorial Board member of Pediatric Drugs. Dr Aloi was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions.All other authors have no financial disclosures or conflicts of interest related to the article to declare. Ethical approval: Not applicable Consent to participate/Consent to publish: Not applicable Availability of data and material: Not applicable Code availability: Not applicable. Author contributions: Giulia D’Arcangelo, as first author, contributed substantially to the conception and development of the manuscript. She performed the literature search and review, analyzed and interpreted the relevant literature, drafted the manuscript, and critically revised its content throughout the writing process. Silvana Ancona contributed to the literature search and review, conducted the figure production, and contributed to the writing of the manuscript. Giulia Naspi Catassi contributed to the literature search, figure editing, revision of the manuscript draft, and approval of the final version for publication. Francesca Musto contributed to the literature search, figure editing, revision of the manuscript draft, and approval of the final version for publication. Rosaria Celano contributed to the literature search, figure editing, revision of the manuscript draft, and approval of the final version for publication. Marina Aloi, as corresponding author, contributed to the conception of the manuscript, supervised the overall process, critically reviewed the content, edited and revised the final version, and approved the final version for publication. |
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| Substance Nomenclature: | 0 (Immunosuppressive Agents) |
| Entry Date(s): | Date Created: 20260611 Date Completed: 20260717 Latest Revision: 20260813 |
| Update Code: | 20260813 |
| PubMed Central ID: | PMC13379467 |
| DOI: | 10.1007/s40272-026-00751-8 |
| PMID: | 42274988 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1179-2019 |
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| DOI: | 10.1007/s40272-026-00751-8 |