TOPLINE:

In children with inflammatory bowel disease (IBD), multiple intramolecular switches among anti-TNF agents were not associated with reduced treatment persistence, increased relapse, or higher adverse events.

METHODOLOGY:

• Researchers conducted a retrospective cohort study across seven paediatric IBD centres in Italy to determine whether multiple intramolecular switching between biologics of the same anti-TNF class (infliximab or adalimumab) affects efficacy, safety, or immunogenicity in children with IBD (January 2011 to June 2024).
• A total of 185 children with IBD (median age at diagnosis, 11.9 years; 57.3% boys), including 136 with Crohn's disease and 49 with ulcerative colitis (UC) or IBD unclassified (IBDU), who underwent at least one intramolecular anti-TNF-alpha switch were assessed and followed up for a median of 5.5 years.
• Each anti-TNF‐alpha switch was classified as originator-to-biosimilar, biosimilar-to-originator, or biosimilar-to-biosimilar and was further categorised as medically driven (due to adverse events, loss of response, or disease activity) or non-medical (supply driven).
• The primary outcome was treatment durability, defined as the probability of remaining on the same anti-TNF-alpha agent until the end of follow-up; secondary outcomes included the incidence of adverse events and disease relapse, defined as the presence of clinically active disease — a Pediatric Crohn's Disease Activity Index score > 10 for Crohn's disease or a Pediatric Ulcerative Colitis Activity Index score > 10 for UC or IBDU.

TAKEAWAY:

• Overall, 21.1% of children discontinued or changed anti‑TNF‑alpha therapy after a median of 25.5 months.
• No significant difference in treatment persistence was observed among children who underwent one, two, or three switches.
• After the first switch, 8.1% of children had disease relapse; 4.3% experienced infusion reactions and 3.8% had other adverse events, with no significant differences detected across switch types.
• Medically driven switching independently predicted subsequent anti‑TNF‑alpha therapy discontinuation (adjusted hazard ratio, 3.09; P = .002).

IN PRACTICE:

"[The study] findings support the safety of supervised, nonmedical switching in clinical practice," the authors of the study wrote.

SOURCE:

This study was led by Valeria Dipasquale, University Hospital "G. Martino," Messina, Italy. It was published online on April 20, 2026, in the Journal of Pediatric Gastroenterology and Nutrition.

LIMITATIONS:

This study was limited by its retrospective, single-country design; the predominantly non-medical, supply-driven nature of the switches; and the absence of a non‑switching comparator group. Additionally, therapeutic drug monitoring and antidrug antibody testing were not systematic, and few children underwent two or three switches, reducing the power to detect uncommon events.

DISCLOSURES:

This study did not receive any specific funding. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.