Maarten Cozijnsen

133 Chapter 6 Benefits and risks of combination therapy in children with IBD treatment may reduce the occurrence of ATIs and reduce loss of response rates while minimizing adverse effects. On the other hand, as more and more evidence associates thiopurine use with increase malignancy rates, MTX may be used in combination with anti-TNF therapy instead at least in boys with CD (due to the teratogenicity risk of MTX in teenage girls). However the benefits of combined therapy with MTX have been less studied and proven. A personalized strategy, aiming at balancing the risk and benefit given individual phenotype and predictors, is likely the preferred strategy until more level 1 evidence is available in children. Regardless of the recommendations, families should always be involved in the decision making while providing a balanced view of the pros and cons of each alternative.