Evolution After Anti‐TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long‐Term Follow‐Up Study. (January 2017) - Casanova, M J
Abstract : OBJECTIVES: The aims of this study were to assess the risk of relapse after discontinuation of anti‐tumor necrosis factor (anti‐TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti‐TNF in those who relapsed. METHODS: This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti‐TNFs and in whom these drugs were discontinued after clinical remission was achieved were included. RESULTS: A total of 1, 055 patients were included. The incidence rate of relapse was 19% and 17% per patient‐year in Crohn's disease and ulcerative colitis patients, respectively. In both Crohn's disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient‐year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confidence interval (CI)=1.01–1.66), elective discontinuation of anti‐TNFs (HR=1.90; 95% CI=1.07–3.37) or discontinuation because of adverse events (HR=2.33; 95% CI=1.27–2.02) vs. a top‐down strategy, colonic localization (HR=1.51; 95% CI=1.13–2.02) vs. ileal, and stricturing behavior (HR=1.5; 95% CI=1.09–2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn's disease patients, whereas treatment with immunomodulators after discontinuation (HR=0.67; 95% CI=0.51–0.87) and age (HR=0.98; 95% CI=0.97–0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti‐TNF was effective (80% responded) and safe. CONCLUSIONS: The incidence rate of inflammatory bowel disease relapse after anti‐TNF discontinuation is relevant. Some predictive factors of relapse after anti‐TNF withdrawal have been identified. Retreatment with the same anti‐TNF drug was effective and safe.