Infliximab at diagnosis: moving towards personalisation in paediatric inflammatory bowel disease.

The optimal strategy for induction of remission in paediatric Crohn’s disease, and in particular the timing of introduction of monoclonal antibody therapy, remains controversial. This has long-term implications in a condition where short-term benefit, including impact on growth, must be balanced against the potential need for treatment escalation and risks associated with therapy. This is not helped by the fact the condition is heterogeneous in type, distribution and severity. International guidance currently recommends that children presenting with moderate to severe luminal disease are commenced on exclusive enteral nutrition (EEN), oral corticosteroids, intravenous corticosteroids or anti-TNF therapy, with widespread use of EEN as first line.1 In their ground-breaking article, Jongsma et al describe the use of anti-TNF therapy for induction of remission, and compare this to ‘conventional’ therapy in an open-label randomised control trial.2 All patients had moderate to severe disease. The data are novel and have the potential to inform practice. Rather than focusing on the continued debate between top-down versus step-up therapy, these data inform paediatric gastroenterologists on the utility of induction therapy with infliximab, with the protocol dictating patients who are able should stop the drug after the final infusion at 22 weeks. The results of the study, conducted on 100 patients, highlight the efficacy of infliximab (59%) to …