Clinical and biological consequences of immunization to infliximab in pediatric Crohn's disease

Clin Immunol. 2006 Jan;118(1):11-9. doi: 10.1016/j.clim.2005.07.010. Epub 2005 Aug 25.


Tumor necrosis factor (TNF)-alpha plays a critical role in the initiation and progression of Crohn's disease, a chronic inflammatory disorder of the gastrointestinal tract. Infliximab, a chimeric monoclonal antibody blocking TNF-alpha, has proven effective as an induction and maintenance therapy for refractory Crohn's 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-alpha and infliximab were influenced by the presence of anti-infliximab antibodies. We propose that surveillance of circulating infliximab and/or TNF-alpha concentration during maintenance therapy represents an indirect but reliable method to monitor anti-infliximab immunization.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Antibodies, Anti-Idiotypic / blood
  • Antibodies, Anti-Idiotypic / metabolism
  • Antibodies, Blocking / blood
  • Antibodies, Blocking / metabolism
  • Antibodies, Monoclonal / blood
  • Antibodies, Monoclonal / immunology*
  • Antibodies, Monoclonal / therapeutic use*
  • Child
  • Child, Preschool
  • Crohn Disease / drug therapy*
  • Crohn Disease / immunology*
  • Female
  • Humans
  • Immunization / adverse effects
  • Infant
  • Infliximab
  • Male
  • Retrospective Studies
  • Time Factors
  • Tumor Necrosis Factor-alpha / immunology
  • Tumor Necrosis Factor-alpha / metabolism


  • Antibodies, Anti-Idiotypic
  • Antibodies, Blocking
  • Antibodies, Monoclonal
  • Tumor Necrosis Factor-alpha
  • Infliximab