Subcutaneous infliximab holds remission in children with IBD after switching

Design

Systematic review and meta-analysis of 5 single-arm cohorts (low certainty)

Population

162 children with IBD on subcutaneous infliximab, mostly switched from IV

Primary outcome

Treatment persistence and clinical remission at ~6 months

Effect

Persistence 89.8%; remission 90.2%; infliximab level 11.4→21.9 µg/mL; antidrug antibodies 0.7%

Subcutaneous infliximab is licensed for maintenance in adults with inflammatory bowel disease but used off-label in children. This first paediatric-only meta-analysis pooled five cohorts (162 children, 70% Crohn's disease) treated with subcutaneous infliximab, almost all switched from intravenous therapy while in remission.

Over about six months, treatment persistence was 89.8% and clinical remission near the six-month mark 90.2%. Serum infliximab concentrations roughly doubled after the switch (11.4 to 21.9 µg/mL), new antidrug antibodies were rare (0.7%), serious adverse events uncommon (1.5%), and injection-site reactions occurred in 11%.

The practical read is that switching a child in remission from infusions to subcutaneous dosing is reasonable, trading infusion visits for home injections with steadier drug levels. Two caveats: the certainty of evidence is low, and because almost everyone switched while already in remission, this says nothing about whether subcutaneous infliximab can induce remission from scratch.

• Switching children in remission to subcutaneous infliximab held remission in about 90%.
• Drug levels roughly doubled and new antidrug antibodies were rare.
• Injection-site reactions occurred in about 11%; serious adverse events were uncommon.
• The data cover switching in remission, not inducing remission de novo.

Why it matters

It supports trading infusion visits for home injections in paediatric IBD, where convenience affects adherence.

Don't overread it

Low-certainty, single-arm pooled data in children already in remission — it does not show subcutaneous infliximab can induce remission.

The statistics, in plain English

Single-arm proportions near 90% look strong but have wide confidence intervals and no comparator, so they describe what happened after switching rather than proving superiority over continued infusions.

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