Proactive Drug Monitoring May Reduce Escalation in Pediatric IBD on Infliximab
Proactive therapeutic drug monitoring (pTDM) during infliximab maintenance therapy may reduce the need for rescue treatment in pediatric inflammatory bowel disease (IBD), according to a randomized controlled trial evaluating clinical outcomes over one year.
The single-center trial enrolled 51 patients aged 5 to 21 years with moderate to severe Crohn’s disease or ulcerative colitis. Before randomization, most patients (72.5%) required dose optimization to reach target infliximab concentrations, which was associated with improved disease activity scores. Patients were then assigned to either standard of care, with treatment guided by clinical symptoms alone, or a pTDM strategy that incorporated infliximab levels regardless of clinical status.
Over 52 weeks, the primary outcome—need for rescue therapy—occurred less frequently in the pTDM group compared with standard care (9.5% vs 22%). While this difference did not reach statistical significance, the trend favored proactive monitoring.
The authors concluded that “proactive TDM was associated with reduced need for rescue therapy compared to standard of care,” noting that the findings were “clinically relevant” despite limited sample size. They emphasized that further studies are needed to determine optimal timing and implementation strategies.
Although larger trials are needed to confirm these findings, pTDM may represent a useful strategy in pediatric IBD, particularly for patients at risk of loss of response. Integrating pharmacokinetic data with clinical assessment could support more precise, individualized management during maintenance therapy.
Reference
Abbas R, O Haidar O, Al Neirab A, N Ibrahim. Journal of Crohn's and Colitis. 2026; 20(S1): jjaf231.1266. https://doi.org/10.1093/ecco-jcc/jjaf231.1266
