Switching from Intravenous to Subcutaneous Infliximab in Children with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.
Elizabeth A Spencer
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In 30 seconds
This systematic review and meta-analysis synthesized six independent, largely observational cohorts of children with inflammatory bowel disease who switched from intravenous to subcutaneous infliximab (n = 173). Pooled treatment persistence was 92% (95%CI 84-98), and maintained clinical remission was 93% (95%CI 84-99). Any-cause discontinuation was 8% (95%CI 2-16), most often because of injection-site intolerance, relapse, or paradoxical dermatitis. The findings suggest that remission was generally maintained after switching, with rare new anti-drug antibody formation in cohorts assessing immunogenicity.
Key findings
- Across six cohorts (n = 173), pooled treatment persistence was 92% (95%CI 84-98).
- Pooled maintained clinical remission was 93% (95%CI 84-99).
- Any-cause discontinuation was 8% (95%CI 2-16), most often for injection-site intolerance, relapse, or paradoxical dermatitis.
- Among 129 children in cohorts measuring immunogenicity, four developed new anti-drug antibodies; none were sustained.
Why it matters
The pooled results provide a useful summary of pediatric real-world experience with a route of administration that may reduce travel and infusion-center use. They also address concerns about maintaining remission and immunogenicity after switching. However, the evidence remains based on small, largely observational cohorts, and subcutaneous infliximab is not approved for patients younger than 18 years.
What to keep in mind
The evidence comes from six small, largely observational cohorts; the review notes that prospective validation is needed.