Abstract Background Inflammatory bowel disease (IBD) in children, including Crohn’s disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U), requires early and effective intervention to achieve remission and prevent complications. Infliximab (IFX), an anti-TNF agent, is a mainstay of therapy, and proactive therapeutic drug monitoring (TDM) during induction may optimize outcomes, though limited pediatric data are available. Methods A retrospective cohort study was conducted at Sidra Medicine, including pediatric IBD patients treated with IFX from 2015 to 2024. Proactive TDM involved scheduled drug level assessments before doses 2, 3, and the first maintenance dose and infliximab dose escalation were done when levels were low from target during induction. Disease activity was assessed using the Pediatric Crohn’s Disease Activity Index (PCDAI), Pediatric Ulcerative Colitis Activity Index (PUCAI), and fecal calprotectin at baseline and 12 weeks. Patients were stratified by TDM approach, and statistical analyses were performed using R software and Jamovi software. Results Of 148 patients included, 82.4% underwent proactive monitoring. By week 12, PCDAI and PUCAI scores significantly decreased (mean PCDAI: 42.3 to 5.93, p 0.0001 and mean PUCAI: 42.6 to 7.19, p = 0.0044). Fecal calprotectin mean levels declined from 1544 µg/g to 425.7 µg/g (p 0.0001). Patients with proactive monitoring demonstrated superior remission rates and lower disease activity scores. Conclusion Proactive therapeutic drug monitoring during infliximab induction is associated with improved early clinical remission and biochemical response in pediatric Inflammatory bowel disease. This approach might result in early sustained remission that might modify the course of the disease. Conflict of interest: Dr. Abbas, Rasha: No conflict of interest Haidar, Omer: No conflict of interest Al Neirab, Abdallah: No conflict of interest Ibrahim, Nazira: No conflict of interest Abdelrahman, Hatim: No conflict of interest Al-Mudahka, Fatma: No conflict of interest Akobeng, Anthony k: No conflict of interest Elawad, Mamoun Abdelrahman: No conflict of interest
Abbas et al. (Thu,) studied this question.