Subcutaneous infliximab for maintenance therapy in children and adolescents with inflammatory bowel disease: a systematic review and meta-analysis

Subcutaneous infliximab is licensed for maintenance only in adults with inflammatory bowel disease, and pediatric evidence sits in small cohorts never pooled. We estimated the effectiveness, pharmacokinetics, immunogenicity, and safety of subcutaneous infliximab as maintenance therapy in children and adolescents with inflammatory bowel disease. We searched MEDLINE, Embase, Web of Science, CENTRAL, and trial registries from inception to 12 July 2026. Eligible studies were observational cohorts and case series of at least five children under 18 years old treated with subcutaneous infliximab after a switch from intravenous infliximab or de novo. Single-arm proportions were pooled with a random-effects model. Five cohorts (162 children; 113 [70%] Crohn disease, 45 [28%] ulcerative colitis, 4 [2%] unclassified) were included. Over a median follow-up of about 6 months (range 12 weeks to 12 months), treatment persistence was 89.8% (95% CI 72.6-99.0) and clinical remission at the closest timepoint to 6 months was 90.2% (61.3-100). Serum infliximab concentration roughly doubled after the switch (pooled mean 11.4 to 21.9 µg/mL), and new antidrug antibodies were rare (0.7%). Clinical relapse occurred in 4.8%, serious adverse events in 1.5%, and injection site reactions in 11.0%. Certainty of evidence was low to very low.