Overview of biologic drugs in children and adolescents

The 46th National Association of Pediatric Nurse Practitioners (NAPNAP) conference featured a presentation on biologic drugs in children and adolescents, led by Teri Woo, PhD, ARNP, CPNP-PC, FAANP. The presentation covered the role of biologics in pediatric care, their applications in various conditions, and safety considerations for clinicians.

The role of biologics in pediatric care

Biologic drugs include monoclonal antibodies, gene therapies, and recombinant proteins. Unlike traditional small-molecule drugs, biologics are derived from living organisms and are designed to target specific pathways involved in disease processes.

Biologics have been used in adult populations for conditions such as rheumatoid arthritis, psoriasis, and cancer. Their applications in pediatrics continue to expand, with biologics playing a role in managing autoimmune diseases, hematologic disorders, inflammatory conditions, and certain genetic disorders. Common indications for biologic therapy in children include juvenile idiopathic arthritis (JIA), inflammatory bowel disease (IBD), severe asthma, hemophilia, and atopic dermatitis.

Common pediatric applications of biologics

The presentation addressed the use of biologics in autoimmune and inflammatory diseases. Tumor necrosis factor (TNF) inhibitors such as etanercept (Enbrel) and adalimumab (Humira) are used in the treatment of JIA to reduce inflammation and slow disease progression. Interleukin inhibitors such as tocilizumab (Actemra) and dupilumab (Dupixent) are also used for conditions like systemic JIA and moderate to severe atopic dermatitis.

Biologics are also used in hematologic conditions such as hemophilia A and B. Factor replacement therapies and newer agents like emicizumab (Hemlibra) are used to reduce bleeding episodes. In patients with sickle cell disease, crizanlizumab (Adakveo) is used to reduce the frequency of vaso-occlusive crises.

Safety considerations and clinical implications

Woo emphasized the importance of monitoring for potential risks, including immunosuppression, infection risk, and adverse effects such as malignancy. Live vaccines should generally be avoided in children receiving biologics, and clinicians must assess each patient’s immunization status before initiating therapy.

Another consideration is the development of antidrug antibodies, which can reduce the efficacy of biologic therapies. Regular assessments of treatment response and potential adverse events are necessary. Woo also noted that cost and insurance coverage can be barriers to accessing biologic therapies.

Conclusion

The applications of biologics continue to expand, and clinicians must remain informed about their indications and safety considerations. Ongoing monitoring, patient assessment, and awareness of treatment barriers are important factors in the effective use of biologics in pediatric care.

Reference:

Woo T. Biologic Drugs in Children and Adolescents: Primary Care Essentials. Presented at: The 46th National Association of Pediatric Nurse Practitioners (NAPNAP) conference. Chicago, Illinois.