Infliximab (IFX), a monoclonal antibody that targets tumor necrosis factor-alpha, is an effective therapy for inflammatory bowel disease (IBD). Children’s dosing regimens are extrapolated from adult data using a set, weight-based dosage, which is frequently insufficient. While clinical trials have focused on safety and effectiveness, there is little information on the pharmacokinetics and immunogenicity of IFX in children. The goal of this study was to offer a comprehensive review of the current literature on the pharmacokinetics and immunogenicity of IFX in children with IBD in order to determine the validity of current adult to pediatric dosage extrapolation. A search of the literature yielded publications up to October 2018. Eligibility criteria were a research population of children and/or adolescents with IBD, a report of IFX trough levels and/or antibodies to IFX, a full-text publication or abstract, an English-language paper, and original data. The initial computerized search returned 2360 possibly relevant articles, with 1831 remaining after duplicates were removed. Another search found 202 possibly related articles. 2000 articles were removed from the 2033 retrieved articles due to title, abstract, or eligibility requirements. IFX clearance was enhanced in young children and children with severe illness, resulting in lower trough levels with an extrapolated dosage of 5 mg/kg, the development of antibodies to IFX, and consequently decreased effectiveness.

Extrapolating adult to pediatric weight-based dosage is frequently insufficient. The study discusses many factors to consider when administering IFX in children and adolescents with IBD.