Risk of Infections With Infliximab vs Adalimumab Among Children With Inflammatory Bowel Disease
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By
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Ning Lyu
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Michaela Tracy
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Sebastian Schneeweiss
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Timothy J. Savage
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July 10, 2026
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Clinical Scorecard: Comparative Infection Risks Associated with Infliximab and Adalimumab in Pediatric Inflammatory Bowel Disease Patients
At a Glance
| Category | Detail |
|---|
| Condition | Pediatric Inflammatory Bowel Disease (IBD) |
| Key Mechanisms | Infliximab and adalimumab are anti-TNF therapies used to treat IBD. |
| Target Population | Children with IBD, including Crohn disease and ulcerative colitis. |
| Care Setting | Routine clinical practice |
Key Highlights
- Pediatric IBD prevalence is estimated at 122 per 100,000 children in the US.
- 43% of children with IBD receive biologic therapy before age 18.
- Infections are a significant safety concern in children with IBD.
- No head-to-head trials have compared the safety of infliximab and adalimumab in pediatric patients.
- Current guidelines recommend both infliximab and adalimumab as first-line treatments.
Guideline-Based Recommendations
Diagnosis
- Use ICD-10 codes for Crohn disease (K50.xx) and ulcerative colitis (K51.xx) for diagnosis.
Management
- Infliximab and adalimumab are recommended as first-line options for pediatric CD and UC.
Monitoring & Follow-up
- Monitor for serious infections requiring hospitalization and outpatient infections requiring treatment.
Risks
- Children with IBD have a higher rate of serious infections compared to the general population.
Patient & Prescribing Data
Pediatric patients aged 6 to 17 years with IBD.
Study aimed to compare infection risks between infliximab and adalimumab.
Clinical Best Practices
- Ensure a new-user design by excluding prior biologic use.
- Define serious infections requiring hospitalization with validated ICD-10 codes.
- Use appropriate antimicrobial treatment within 1 day for outpatient infections.
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