Switching children with IBD from intravenous to subcutaneous infliximab: remission held, levels rose

Design

Systematic review and proportional meta-analysis of cohorts

Population

6 paediatric cohorts, 173 children with IBD switched IV to SC infliximab

Primary outcome

Treatment persistence and maintained remission

Effect

Persistence 92% (84–98); remission 93% (84–99); SC levels ~2× IV troughs

Subcutaneous infliximab is approved for maintenance after intravenous induction in adults with inflammatory bowel disease, but not under 18. This systematic review, published on 17 October, pooled six paediatric switch cohorts with 173 children.

Pooled treatment persistence was 92% (95% CI 84–98%) and maintained clinical remission 93% (84–99%). Discontinuation for any reason was 8%, mostly for injection-site intolerance, relapse or paradoxical dermatitis. New anti-drug antibodies appeared in four of 129 children tested, none sustained, and existing antibodies often cleared after switching. Steady-state subcutaneous concentrations ran about twice the previous intravenous troughs, as expected from continuous absorption rather than peak-and-trough dosing. Families valued fewer missed school days and less travel.

The evidence is observational and small, so the remission figures describe selected children who were switched, not all comers. The doubled concentrations matter for therapeutic drug monitoring: subcutaneous levels should not be read against intravenous trough targets.

• Subcutaneous infliximab is not licensed under 18; any use in children is off-label and needs documented consent.
• Do not interpret subcutaneous infliximab levels against intravenous trough targets; expect them to be roughly twice as high.
• Check for anti-drug antibodies before and after switching in children with prior immunogenicity.
• Watch for injection-site reactions and paradoxical dermatitis after switching.

Why it matters

The route change alters the concentration profile, so monitoring rules built for infusions do not transfer directly.

Don't overread it

Small observational cohorts of selected children; this does not establish efficacy or support routine off-label use.

The statistics, in plain English

Proportional meta-analysis pools percentages across cohorts. A remission rate of 93% with an interval of 84–99% reflects six small, selected groups; without a comparison arm, it cannot show subcutaneous dosing is better or equal to staying on infusions.

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