Biological therapy in paediatric inflammatory bowel disease – right patient to prescribe it

25% of inflammatory bowel disease (IBD) patients are from paediatric population. During the last decade, the role and indications for the use of anti-tumor necrosis factor (TNF) therapy in paediatric IBD have changed and becomes more challenging. From 2011. Anti-TNF therapy with Infliximab (IFX) and Adalimumab (ADA) has been started in Latvia. This is retrospective study reviewing the data of all the IBD patients from Children’s Clinical University Hospital of Latvia medical records with the diagnosis of Crohn’s disease (CD) and ulcerative colitis (UC) from 1st January 2011 to 31st July 2020 and who had biological therapy. We collected the data of age at diagnosis, sex, used biological therapy, disease activity index (AI) (CD -PCDAI and UC-PUCAI), fistulas, abscesses, operations, steroid resistances. 30 children had biological therapy. 80% (n=24) had CD, 20% (n=6) had UC. The mean age at diagnosis was 13 years 8 months. 47% (n=14) received IFX, 30% (n=9) ADA, 23% (n= 7) required both agents. First biologic agent for CD was 58.3% IFX (n=14), 41.7% ADA (n=10). For UC: 83.3% (n=5) IFX, 16.7% (n=1) ADA. 44% (n= 11) CD patients had fistulas and 36.3% (n=4) of them had abscesses. Small intestine involvement in CD is associated with higher risk for surgery (p-0.044). Disease AI before and after the start of treatment was calculated in 80.6% (n=25): 37.9 points and 15.4 points. The sooner the therapy is started, the better therapeutic effect for CD patients (p-0.007). Biological therapy indications in paediatric IBD are not only related to CD or UC activity index, but also to previous therapies effectiveness or resistance and disease localisation.