Switching Between Anti-TNFs and Other Biologic Drugs in Paediatric Inflammatory Bowel Disease: A Narrative Review and Practical Clinical Guide.

What To Know

The review highlights that intra-class switching between anti‑TNFs (for example, infliximab to adalimumab) leads to remission in a portion of children, with better results when intolerance or secondary loss of response is the reason for switching than when there is primary non‑response.

Therapeutic drug monitoring (TDM) is central to the authors' recommended approach: low drug levels (with or without anti‑drug antibodies) point toward dose optimization or within‑class switching, whereas pharmacodynamic failure (adequate levels but no response) favors changing to a different drug class (such as vedolizumab, ustekinumab, or newer agents like upadacitinib).

The authors propose an evidence‑informed clinical framework that integrates objective disease assessment, TDM, phenotype (Crohn's vs UC), and prior treatment exposure to guide sequencing.

They note that vedolizumab may perform better in UC and ustekinumab may be more effective in CD after anti‑TNF exposure, while paediatric data for JAK inhibitors and S1P modulators remain limited.