Anti-TNF Drugs for Children With Crohn's Disease: What a 2025 Cochrane Systematic Review Found

Crohn's disease does not only affect adults. Around one in four people diagnosed with Crohn's receive that diagnosis before the age of 18, and managing the disease in a growing child carries considerations that go beyond those in adult care. Under-controlled inflammation can affect a child's growth and nutritional development; long-term medicines come with their own risks in a developing body; and the randomised trial evidence in children, while growing, remains smaller than in adults. A 2025 Cochrane systematic review set out to synthesise that evidence specifically, examining the randomised controlled trials on tumour necrosis factor-alpha (TNF-alpha) antagonists for treating Crohn's disease in children and adolescents. (Sepúlveda A et al., Cochrane Database Syst Rev, 2025 Aug 1)

What TNF-Alpha Antagonists Are

The immune system produces a protein called TNF-alpha that signals other immune cells to mount an inflammatory response. In Crohn's disease, this response becomes dysregulated, driving ongoing damage to the gut lining. Anti-TNF drugs bind to TNF-alpha and block its activity, reducing the inflammatory cascade.

The two main TNF-alpha antagonists studied in children with Crohn's disease are infliximab and adalimumab. Infliximab is given by intravenous infusion in a clinic, typically every eight weeks after an initial loading period. Adalimumab is injected under the skin, which some families find more practical for ongoing treatment. Both require a clinical environment for initiation and monitoring. (Sepúlveda A et al., 2025)

The NHS describes Crohn's disease as a lifelong condition in which inflammation can affect any part of the digestive tract and cause complications beyond the gut. In children, active disease can also disrupt growth and nutritional status, making early and adequate disease control particularly important. (NHS: Crohn's disease)

What the Cochrane Review Covers

A Cochrane systematic review identifies and combines results from randomised controlled trials (RCTs), which are considered the most reliable study design for assessing whether a treatment is effective. By pooling results from multiple RCTs, a Cochrane review can produce a clearer picture of the overall evidence than individual studies allow.

The 2025 review by Sepúlveda and colleagues focused specifically on the paediatric population, in whom the number of available RCTs is smaller than in adults. This is partly because randomised trials in children involve additional ethical and logistical considerations, and trial participant numbers are inherently smaller. The review was published on 1 August 2025 in the Cochrane Database of Systematic Reviews. (Sepúlveda A et al., 2025)

Where Anti-TNF Treatment Fits

Anti-TNF therapy is typically considered for children whose Crohn's disease has not responded adequately to conventional treatments, including corticosteroids used for short-term flare control and immunomodulators such as azathioprine or mercaptopurine used for longer-term maintenance.

Before starting anti-TNF treatment, screening for tuberculosis and hepatitis B is standard, because these medicines reduce the immune response that keeps certain infections in check. Regular monitoring continues during treatment, and clinical teams assess response, side effects, and whether the drug remains effective over time. (Sepúlveda A et al., 2025)

Context From the Adult Evidence

A 2026 Cochrane network meta-analysis comparing all biologic and advanced therapy classes for adult Crohn's disease found that biologics as a class are substantially more effective than conventional treatments for inducing and maintaining remission. (Gordon M et al., Cochrane Database Syst Rev, 2026 Jun 23) The 2025 review by Sepúlveda and colleagues addresses the specific question of whether and to what extent that evidence translates to children, a population with distinct physiological and developmental needs.

What This Means for Families

A Cochrane systematic review provides the most rigorous available summary of the randomised trial evidence, but it does not replace the individualised clinical assessment of a specific child. Disease severity, prior treatment history, growth trajectory, nutritional status, and other health factors all shape the treatment plan for any given patient.

If your child has Crohn's disease and you have questions about biologic treatment options, including whether anti-TNF drugs might be appropriate, the right conversation is with a paediatric gastroenterologist who knows your child's full clinical picture. Decisions about starting, switching, or stopping any biologic therapy should be made jointly between your family and your child's care team.