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Week 14 Infliximab Level Provides Modest Benefit to Clinical Outcomes in Children with Crohn's Disease

Asha Jois1, Rachel Horn1, Anysha Walia1

  • 1Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, VIC, Australia.

Pediatric Gastroenterology, Hepatology & Nutrition
|May 18, 2026
PubMed

Insights

Determining infliximab (IFX) drug levels early in children with Crohn's disease showed no significant difference in treatment failure rates. However, a proactive approach may offer minor benefits in biochemical markers like C-reactive protein.

Area of Science:

  • Pediatric Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Crohn's disease management in children requires effective therapeutic strategies.
  • Infliximab (IFX) is a key biologic therapy for pediatric Crohn's disease.
  • The optimal timing and utility of therapeutic drug monitoring (TDM) for IFX in this population remain under investigation.

Purpose of the Study:

  • To compare 6- and 12-month outcomes in pediatric Crohn's disease patients commencing IFX.
  • To evaluate the impact of determining IFX drug levels at week 14 (W14 group) versus not (NoW14 group).
  • To assess differences in clinical and biochemical disease activity, IFX persistence, and failure rates.

Main Methods:

  • Retrospective, single-center study of 83 children (0-18 years) with Crohn's disease receiving IFX induction (2018-2021).
  • Patients were divided into W14 (IFX level determined at week 14) and NoW14 groups.
  • Outcomes including disease activity, IFX levels, dose, frequency, and failure (biologic switch, corticosteroid use, hospitalization, surgery) were compared at 6 and 12 months.

Main Results:

  • No significant difference in 12-month failure rates (33% vs. 33%) or IFX persistence (98% vs. 95%) between W14 and NoW14 groups.
  • No difference in IFX drug levels at 6 or 12 months between the groups.
  • The W14 group showed a greater reduction in C-reactive protein and increase in albumin at 12 months.

Conclusions:

  • Knowledge of week 14 infliximab levels, without defined response thresholds, offers limited benefit for children with Crohn's disease.
  • Proactive TDM may have a minor positive impact on biochemical markers of inflammation.
  • Further research is needed to define optimal TDM strategies in pediatric IBD.
Abstract

Keywords:
Crohn diseaseDrug monitoringPediatrics

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