Maarten Cozijnsen

57 Chapter 3 TISKids: an international multicenter RCT be confirmed in a prospective randomized trial. Also, the top-down strategy by definition aims at stopping IFX therapy and stepping down to immunomodulator monotherapy. This is to reduce risks associated with combination therapy(13), limit healthcare expenses while – hopefully – not compromising in efficacy. Whether this approach truly offers the best risk/cost/benefit balance still needs to be tested. This study therefore aims to compare the efficacy and safety of the top-down IFX treatment with conventional step-up treatment in pediatric CD patients with moderate-to-severe disease.