- Design
- Systematic review and proportional meta-analysis of observational cohorts
- Population
- 173 children with IBD switched from IV to SC infliximab, six cohorts
- Primary outcome
- Treatment persistence and maintained remission
- Effect
- Persistence 92% (95% CI 84–98); remission 93% (84–99)
A systematic review pooled six cohorts with 173 children with inflammatory bowel disease who switched from intravenous to subcutaneous infliximab maintenance after intravenous induction.
Treatment persistence was 92% and clinical remission was maintained in 93%. About 8% stopped, most often for injection-site reactions, relapse or paradoxical dermatitis. New anti-drug antibodies were rare, and drug levels were roughly double prior intravenous troughs, as expected with continuous subcutaneous absorption. Families valued less school absence and travel.
Subcutaneous infliximab is licensed in adults but not under 18 in most countries, so use in children is off-label, and the evidence is small, observational and without a control group. For adolescents managing school and travel to infusion units, it is a reasonable discussion where access allows.
- Consider subcutaneous infliximab for stable children after intravenous induction, recognising it is off-label under 18.
- Check drug levels and antibodies before and after switching.
- Teach injection technique and review injection-site reactions early.
- Document consent for off-label use and the reasons for it.
Why it matters
Moving maintenance out of the infusion unit changes daily life for children and families.
Don't overread it
Small observational cohorts without comparison; not a licensed paediatric indication.
The statistics, in plain English
Pooled proportions from single-arm cohorts describe what happened after switching but cannot show it is as good as continuing intravenous treatment.
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