Clinical and biological consequences of immunization to infliximab in pediatric Crohnʹs disease

Tumor necrosis factor (TNF)-α plays a critical role in the initiation and progression of Crohnʹs disease, a chronic inflammatory disorder of the gastrointestinal tract. Infliximab, a chimeric monoclonal antibody blocking TNF-α, has proven effective as an induction and maintenance therapy for refractory Crohnʹs disease in adult and pediatric patients. However, infliximab therapy induces the appearance of neutralizing anti-infliximab antibodies. In the pediatric cohort, we analyzed (n = 28) sensitization occurred in 35.7% patients and was associated with a loss of response to maintenance infusions. In two patients presenting high titers of anti-infliximab antibodies, severe infusion reactions were observed, possibly IgE-mediated, precluding further use of the medication. Serum concentrations of TNF-α and infliximab were influenced by the presence of anti-infliximab antibodies. We propose that surveillance of circulating infliximab and/or TNF-α concentration during maintenance therapy represents an indirect but reliable method to monitor anti-infliximab immunization.