Subcutaneous infliximab holds remission in children with IBD after switching

Design

Systematic review and meta-analysis of five observational cohorts

Population

162 children and adolescents with inflammatory bowel disease

Primary outcome

Treatment persistence, remission, drug levels and safety after switching

Effect

Persistence 89.8%, remission 90.2% at 6 months; antidrug antibodies 0.7%

Subcutaneous infliximab is licensed for maintenance only in adults with inflammatory bowel disease, and paediatric use has rested on small single-centre cohorts. This first meta-analysis confined to children pooled five cohorts, 162 patients, most with Crohn disease.

After a switch from intravenous infliximab, results were encouraging: treatment persistence was about 90% and clinical remission near 90% at six months, serum drug concentrations roughly doubled, and new antidrug antibodies were rare at under 1%. Serious adverse events were uncommon, and injection-site reactions occurred in about 11%. The certainty of evidence was low to very low, and almost all children switched while already in remission.

The practical read is that switching a child in remission from intravenous to subcutaneous infliximab looks safe and effective, and can spare infusion visits. It does not show that starting subcutaneous infliximab from scratch can induce remission, which needs prospective trials.

• First paediatric-only meta-analysis of subcutaneous infliximab maintenance: five cohorts, 162 children.
• Treatment persistence and clinical remission were both about 90% at six months after switching.
• Serum infliximab concentrations roughly doubled after the switch from intravenous therapy.
• New antidrug antibodies were rare (under 1%); serious adverse events were uncommon.
• Almost all children switched while already in remission.

Why it matters

It supports moving stable children off infusion schedules, but only as a maintenance switch, not as a way to induce remission.

Don't overread it

The evidence is low to very low certainty and switch-only; it does not establish that starting subcutaneous infliximab de novo can induce remission.

The statistics, in plain English

Single-arm pooled proportions near 90% look impressive but have no comparison group, and the wide confidence intervals (remission 61% to 100%) reflect few, small studies. These are consistent with benefit but cannot be read as a controlled effect.

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