Children switched from intravenous to subcutaneous infliximab stayed in remission in pooled real-world cohorts

The edition in brief

A systematic review and meta-analysis in Current Gastroenterology Reports, published on 17 October, pooled six paediatric cohorts (173 children) switched from intravenous to subcutaneous infliximab maintenance for inflammatory bowel disease. Treatment persistence was 92% and maintained clinical remission 93%; new anti-drug antibodies were rare and often resolved, and drug levels ran about twice previous IV troughs. Families valued less school absence and travel. The formulation is licensed only for adults, and the evidence is observational, so a switch is off-label. A screening study in Gut tested faecal calprotectin in 331 asymptomatic first-degree relatives of people with Crohn's disease: 19% had persistently raised levels, and 2.7% had endoscopic findings compatible with presymptomatic Crohn's; a level above 225 µg/g identified these well. This is a framework for prevention trials, not a screening recommendation. In a 360-patient factorial trial of older adults having bidirectional endoscopy, adjunctive oliceridine reduced supplemental sedative use and slightly shortened recovery, but increased hypotension by about 16 points. The pearl covers what else raises calprotectin.