Drug Name |
Target |
Mechanism of Action |
Additional Information |
Infliximab |
TNF-alpha |
Binds and blocks TNF-alpha preventing activation of downstream proinflammatory signalling |
Multiple biosimilars available. Licensed and NHS funding from 6 years of age. SC infliximab not yet funded |
Adalimumab |
TNF-alpha |
Binds and blocks TNF-alpha preventing activation of downstream proinflammatory signalling |
Multiple biosimilars available. Licensed from 6 years of age but NHS funding from 2 years of age |
Ustekinumab |
p40 subunit of IL12/IL23 |
Blocks the p40 subunit of both IL12 + IL23 preventing downstream proinflammatory signalling |
Not licenced for pre pubertal children. Licensed from 18 years of age but has NHS funding from post-pubescent |
Vedolizumab |
α4β7 integrin |
Binds and blocks the α4β7 integrin on gut homing T-helper lymphocytes and causes a reduction in gastrointestinal inflammation. |
Not licenced for pre pubertal children. Licensed from 18 years of age but has NHS funding from post-pubescent. |
Risankizumab |
p19 subunit of IL23 |
Humanized IgG1 monoclonal antibody targeting the p19 subunit on the cytokine IL23 preventing downstream proinflammatory signalling |
Licenced for 16–17-year olds in paediatric practice. Licensed from 16 years old for Crohn's disease. NHS funding from post pubescent for Crohn's disease only |
Drug Name |
No Anti-drug antibodies |
Present anti-drug antibodies* |
Low drug level |
Increase dose or increase frequency |
Increase dose or increase frequency (ADA <50th centile). Optimise immunomodulator (ADA <50th centile) Consider intra- or inter class switch if response lost (ADA >50th centile) |
Therapeutic Drug Level |
No action |
Optimise immunomodulator |
High Drug level |
Reduce dose, reduce frequency or no action |
Optimise immunomodulator |
Drug Name |
No Anti-drug antibodies |
Present anti-drug antibodies* |
Low drug level |
Increase dose or increase frequency |
Increase dose or increase frequency (ADA <50th centile) Optimise immunomodulator (ADA <50th centile) Low threshold for intra- or inter- class switch if no improvement (ADA >50th centile) |
Therapeutic Drug Level |
Increase dose to target higher drug levels Consider intra- or inter-class switch if no improvement |
Consider intra- or inter class switch |
High Drug level |
Consider intra- or inter-class switch if no improvement |
Consider intra- or inter class switch |
*Total Infliximab Antibodies
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Vertical Divider
*Total Adalimumab Antibodies
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Document Version:
1.0 Lead Authors: Dr James Ashton, Paediatric Gastroenterologist, UHS Melody Chan, Specialist Paediatric Pharmacist, UHS |
Approving Network:
Wessex Paediatric Gastroenterology, Hepatology and Nutrition Network Date of Approval: Review Due: |
PIER Contact |
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