- Design
- Systematic review and proportional meta-analysis of observational cohorts
- Population
- 173 children with IBD switched from IV to SC infliximab
- Primary outcome
- Treatment persistence and maintained clinical remission
- Effect
- Persistence 92% (84-98); remission 93% (84-99); discontinuation 8%
A systematic review and meta-analysis in Current Gastroenterology Reports, published on 17 October 2026, pooled six independent paediatric cohorts, 173 children with IBD, switched from intravenous to subcutaneous infliximab maintenance.
Pooled treatment persistence was 92% (95% CI 84 to 98) and maintained clinical remission 93% (84 to 99). Discontinuation, 8%, was mostly for injection-site intolerance, relapse or paradoxical dermatitis. Among 129 children tested, only four developed new anti-drug antibodies, none sustained, and existing antibodies often cleared. Drug levels ran about twice previous intravenous troughs. Families reported less school absence and travel, and cost analyses suggested savings from avoided infusion visits.
Subcutaneous infliximab is licensed only for adults, and the paediatric evidence is observational, so a switch is off-label. But the results mirror adult data, and for a child travelling far for infusions the practical gain is large.
- Consider switching selected children in stable remission on IV infliximab to the subcutaneous form, recognising it is off-label under 18.
- Document consent for off-label use and agree how dosing will be monitored.
- Check trough levels after switching; expect higher levels than with IV dosing.
- Watch for injection-site reactions and paradoxical dermatitis.
- Consider the travel and school-time burden of infusions when discussing the switch.
Why it matters
Infusion visits cost children school days and families travel; this shows the switch appears to hold remission.
Don't overread it
Small observational cohorts in selected children; not a licensed paediatric use.
The statistics, in plain English
Pooled proportions from six small cohorts have wide intervals, and children who were switched were likely those doing well, which flatters the figures.
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