Key messages

• Infliximab may result in a slight increase in induction of clinical remission (absence of noticeable symptoms) and endoscopic remission (absence of inflammation seen during examination of the colon) when compared to conventional treatment.

• There is limited evidence to support the use of tumor necrosis factor-alpha antagonists (anti-TNF) therapy for induction of remission in children with Crohn's disease.

• More well-designed studies are needed to compare anti-TNF with other treatments and to explore timing, dosing, and other details related to this treatment.

How is Crohn’s disease treated in children?

Initial treatment options for Crohn’s disease in children are steroids, enteral nutrition (special liquid food mixture containing all the nutrients required to meet nutrition needs), immunomodulators (substances that modify the immune system's activity), and sometimes biologics (drugs made from living organisms) such as anti-TNF.

Due to the more aggressive course of Crohn's disease in children and sometimes extensive inflammation, anti-TNF are frequently used.

What did we want to find out?

We wanted to find out if anti-TNF are safe and effective for induction treatment of Crohn’s disease in children. Induction treatment refers to the initial phase of medication used to reduce inflammation and therefore symptoms to bring about remission (when disease symptoms lessen or go away completely).

What did we do?

We searched for studies that looked at anti-TNF as induction treatment compared with conventional treatment (steroids or enteral nutrition), placebo (dummy treatment), or no treatment in children with Crohn’s disease. We summarized the results of the studies and rated our confidence in the evidence based on factors such as study methods and sizes.

What did we find?

We found only one study including 100 children with Crohn’s disease, aged 3 to 17 years, treated with first-line (first step in managing the disease) infliximab (anti-TNF) (50 children) or conventional treatment (steroids [oral prednisolone] or exclusive enteral nutrition) (50 children). The study was conducted in three European countries. Children were followed for one year.

The results suggest that infliximab may result in a slight increase in induction of clinical remission (absence of noticeable symptoms) and endoscopic remission (absence of inflammation seen during examination of the colon) when compared to conventional treatment. The included study did not look at morbidity (disease) or death related to Crohn's disease due to any cause, or serious or mild unwanted effects.

What are the limitations of the evidence?

We have little confidence in the evidence because it is possible that people in the studies knew which treatment they were getting; the included study was small; and there are not enough studies to be certain about the results.

Larger studies looking at the benefits and harms of anti-TNF compared with conventional treatment for children with active Crohn's disease are needed. Among the important outcomes to be included are morbidity, death, and serious unwanted effects.

How up-to-date is this evidence?

The evidence is current to June 2024.