Anti TNF-a Use in Pediatric Inflammatory Bowel Disease – Reports from a Romanian Center

Background: /Objectives: Treatment armamentarium for inflammatory bowel disease (IBD) has enriched with the advent of anti-tumor necrosis factor (TNF) α molecules, especially infliximab (IFX) and adalimumab (ADA). Besides their incontestable benefits, numerous potential adverse events (AE) are reported to be associated with their use. Our aim was to asses and report the AE for optimal selection and monitoring of patients undergoing these therapies. Methods: A retrospective single-center study was conducted on pediatric IBD patients treated with anti-TNF α at "Grigore Alexandrescu" Emergency Hospital for Children in Bucharest, Romania, from January 2015 to October 2024. AE were classified as: non-infectious complications as acute infusion reactions, anti-drug antibodies formation, dermatological effects such as erythema nodosum (EN) and vasculitis, neurologic effects such as Guillain Barré syndrome and infections. AE were assessed according to the administered molecule and described in detail. Results: Of 40 patients enrolled, 22 (55%) had CD. Median (IQR) age at diagnosis was 14.8 years [10.8-15.9]. IFX was used in 34 (85%) patients while 6 (15%) patients received either ADA or IFX/ADA sequential therapy. Twenty-seven AE were documented in 19 (47.5%) patients, most prevalent being anti-drug antibodies formation, infections and acute infusion reactions. All ADA- treated patients experienced at least one AE, compared to 41.2% in the IFX group, p=.0.01. Conclusions: AE af-fected over half of the patients, with anti-drug antibody formation being most prevalent. ADA treatment was associated with a higher risk of AE compared to IFX. Careful monitoring of patients receiving anti-TNF agents is crucial.