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
Summary
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.
Related Concept Videos
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab (Humira),...
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2 (COX-2),...
01:25Inflammatory Bowel Disease III: Crohn's Disease
Crohn’s disease is a chronic, relapsing form of inflammatory bowel disease characterized by segmental, transmural inflammation that can affect any part of the gastrointestinal tract. Its pathogenesis arises from a combination of genetic susceptibility, environmental exposures, epithelial barrier dysfunction, and immune dysregulation. Together, these factors lead to an exaggerated immune response against components of the gut microbiome.Genetic and Environmental InfluencesMultiple genetic...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...
01:20Inflammatory Bowel Disease IV: Clinical Manifestations
Inflammatory bowel disease (IBD) encompasses two major chronic disorders—ulcerative colitis and Crohn’s disease—each characterized by relapsing episodes of gastrointestinal inflammation. Although they share certain clinical features, their patterns of involvement and manifestations differ in ways that aid diagnosis and guide management.Ulcerative ColitisUlcerative colitis is limited to the colon and rectum and involves continuous inflammation of the mucosal layer. The disease course is marked...