Subcutaneous infliximab as a maintenance option in pediatric IBD: a real-world cohort including younger and lower-weight children.

Authors

Neele Ridder, Johanna Overberg, Laura Kalveram, Samipa Pudasaini, Caroline Ruppel, Leonie Schumm, Stephan Henning, Philip Bufler

Published in

Molecular and cellular pediatrics. Volume 13. Issue 1. Jul 17, 2026. Epub Jul 17, 2026.

Abstract

Subcutaneous infliximab (SC-IFX) offers an alternative to intravenous infliximab (IV-IFX) in adults with inflammatory bowel disease (IBD), but evidence in children is scarce. This study reports treatment persistence, tolerability, and pharmacokinetics in a real-world pediatric IBD cohort following transition from IV-IFX.
We conducted a single center retrospective study including all pediatric IBD patients transitioned from IV-IFX to SC-IFX (120 mg every other week) at our institution between November 2023 and April 2025. Clinical disease activity scores, inflammatory markers, IFX serum concentrations, and anti-IFX antibodies (AIA) were assessed at baseline and during follow-up. The primary outcome was treatment persistence. Secondary outcomes included disease activity, pharmacokinetics, immunogenicity and tolerability.
Twenty patients (median age 14.5 years; range 5-17), including six children < 12 years and five weighing < 40 kg, were included. After a median observation period of 44 weeks (IQR 26-60), 16/20 patients (80%) remained on SC-IFX, with no significant difference between Crohn's disease and ulcerative colitis. In a subgroup of four patients who received SC-IFX as a third dose following two intravenous induction doses, 3/4 (75%) maintained treatment over a median observation period of 60 weeks (range 16-64 weeks) and remained in clinical remission during follow-up. IFX serum concentrations increased after switching (median 11.8 µg/mL pre-switch vs. ≥24 µg/mL at follow-up), with most follow-up measurements reaching the assay ceiling. Concentrations were descriptively comparable between weight groups. All patients with detectable AIA prior to switching became antibody-negative during SC-IFX therapy, and no de novo antibodies were observed. Two patients discontinued therapy due to worsening of pre-existing paradoxical psoriasis. No other adverse events were documented.
SC-IFX showed high persistence, stable inflammatory markers and good tolerability in this pediatric cohort, including younger and lower-weight children. SC-IFX appears to be a feasible maintenance option in selected pediatric patients, including early use after induction. Prospective studies are warranted to define pediatric-specific pharmacokinetic targets and individualized dosing strategies.

PMID:
42463592
Bibliographic data and abstract were imported from PubMed on 17 Jul 2026.

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