Maarten Cozijnsen

64 Discussion TISKids is a unique study specifically designed to compare two treatment strategies. Two comparable groups are generated through randomization so that each group only differs by the initial induction treatment started. During a 5 year follow-up period, the effects of these two strategies will be compared. Both major patient-related outcomes as well as other important healthcare related outcomes will be addressed aiming to obtain as much information as possible concerning the benefits, risks and costs of both strategies. Over the recent years and because of increasing literature supporting early IFX use, IFX is being prescribed increasingly sooner after diagnosis. The guidelines for pediatric CD treatment were changed in their recommendations on this topic: They now advocate first- line IFX use for children with active perianal fistulizing disease and state that first-line IFX may also be considered for patients with high-risk of poor outcome.(5) However, the data supporting this recommendation is not conclusive. The benefits and risks of this new strategy are not well studied, nor compared with those of the conventional step-up strategy. Especially the comparative risks and costs of top-down treatment are not well known. This study will thus offer solid answers to these important and urgent clinical questions.