{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:49:17Z","timestamp":1791485357174,"version":"4.3.4"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the long\u2010term safety, immunogenicity, and treatment durability of multiple sequential intramolecular switches of anti\u2013tumor necrosis factor (TNF)\u2010\u03b1 agents (infliximab and adalimumab) in pediatric inflammatory bowel disease (IBD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicenter, retrospective cohort study was conducted across seven Italian pediatric IBD centers (2011\u20132024) under the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition IBD Working Group. Patients diagnosed with IBD before 18 years and undergoing \u22651 anti\u2013TNF\u2010\u03b1 switch with \u226518 months follow\u2010up were included. Switches were classified as originator\u2010to\u2010biosimilar, biosimilar\u2010to\u2010originator, or biosimilar\u2010to\u2010biosimilar, and as medically or nonmedical (supply\u2010driven). Therapeutic switches between different anti\u2013TNF\u2010\u03b1 molecules (e.g., infliximab to adalimumab or vice versa) were not included. The primary outcome was treatment persistence; secondary outcomes included relapse, adverse events (AEs), and anti\u2010drug antibody detection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 185 patients (57% male; median age 11.9 years) were included; 73.5% had Crohn's disease. Over a median 5.5\u2010year follow\u2010up, 28% underwent a second and 9% a third switch, predominantly nonmedical and biosimilar\u2010to\u2010biosimilar. After the first switch, relapse occurred in 8.1%, infusion reactions in 4.3%, and other AEs in 3.8%, with no differences across switch types. Treatment discontinuation occurred in 21.1%, mainly due to loss of response (48.7%) or AEs (28.2%). Medically driven switching independently predicted discontinuation (hazard ratio; 3.1, 95% confidence interval [CI] 1.5\u20136.4,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Treatment durability did not differ by number of switches (log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.635). At final follow\u2010up, 92.5% were in remission.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multiple, predominantly nonmedical anti\u2013TNF\u2010\u03b1 switches were not associated with increased relapse, AEs, or reduced durability in pediatric IBD. These findings support the safety of sequential switching under physician supervision, though prospective pediatric data remain warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpn3.70443","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T10:02:36Z","timestamp":1776679356000},"page":"71-78","source":"Crossref","is-referenced-by-count":1,"title":["Long\u2010term safety and durability of multiple anti\u2010TNF\u03b1 switches in pediatric inflammatory bowel disease: A Italian society of pediatric gastroenterology, hepatology and nutrition multicenter study"],"prefix":"10.1002","volume":"83","author":[{"given":"Valeria","family":"Dipasquale","sequence":"first","affiliation":[{"name":"Pediatric Gastroenterology and Cystic Fibrosis Unit University Hospital \u201cG. Martino\u201d Messina Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saverio","family":"Pochesci","sequence":"additional","affiliation":[{"name":"Gastroenterology and Nutrition Unit Meyer Children's Hospital Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Morello","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology and Cystic Fibrosis Unit University Hospital \u201cG. Martino\u201d Messina Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Scarallo","sequence":"additional","affiliation":[{"name":"Gastroenterology and Nutrition Unit Meyer Children's Hospital Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Fioretti","sequence":"additional","affiliation":[{"name":"Gastroenterology and Nutrition Unit Meyer Children's Hospital Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Graziano","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Villa Sofia Cervello Hospital Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Citrano","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Villa Sofia Cervello Hospital Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Longo","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology and Endoscopy IRCCS Istituto \u201cGiannina Gaslini\u201d Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Arrigo","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology and Endoscopy IRCCS Istituto \u201cGiannina Gaslini\u201d Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Carciofi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Polytechnic University of Marche Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Gatti","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Polytechnic University of Marche Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Labriola","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology Unit Maggiore \u201cCA Pizzardi\u201d Hospital Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Bramuzzo","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Lionetti","sequence":"additional","affiliation":[{"name":"Gastroenterology and Nutrition Unit Meyer Children's Hospital Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8827-2091","authenticated-orcid":false,"given":"Claudio","family":"Romano","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology and Cystic Fibrosis Unit University Hospital \u201cG. Martino\u201d Messina Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.846151"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000003750"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjw198"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002141"},{"key":"e_1_2_7_6_1","volume-title":"Biosimilar Medicines: Position Paper","author":"Agenzia Italiana del Farmaco (AIFA)","year":"2019"},{"key":"e_1_2_7_7_1","volume-title":"Farmaci generici e biosimilari in pediatria","author":"Agenzia Italiana del Farmaco (AIFA)","year":"2019"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0000000000002408"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12030404"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000000239"},{"key":"e_1_2_7_11_1","unstructured":"The Alliance for Safe Biologic Medicines (ASBM). 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