Evolution After Anti-TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study


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.

DOI: 10.1038/ajg.2016.569

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@article{Casanova2017EvolutionAA, title={Evolution After Anti-TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study}, author={Mar{\'i}a Jos{\'e} Casanova and Mar{\'i}a Chaparro and Valle Garc{\'i}a-S{\'a}nchez and Oscar Nantes and Eduardo Leo and Mar{\'i}a Rojas-Feria and Ar{\'a}nzazu J{\'a}uregui-Am{\'e}zaga and Sandra Garc{\'i}a-L{\'o}pez and J. Mej{\'i}a Huguet and F Arguelles-Arias and Marta Aicart and Ign{\'a}cio Marin-Jim{\'e}nez and Mara{\'i}a G{\'o}mez-Garc{\'i}a and Fernando Mu{\~n}oz and Mar{\'i}a Esteve and Lu{\'i}s Bujanda and Xavier Cort{\'e}s and Joan Tosca and Jos{\'e} Roberto Pineda and M Ma{\~n}osa and Jordina Lla{\'o} and Jordi Guardiola and Isabel P{\'e}rez-Mart{\'i}nez and Carmen Portero Mu{\~n}oz and Yago Gonz{\'a}lez-Lama and Joaqu{\'i}n Hinojosa and Jewel M V{\'a}zquez and Mar{\'i}a Del Pilar Mart{\'i}nez-Montiel and Gilberto E Rodriguez and Ram{\'o}n Pajares and Mariana Fe Garc{\'i}a-Sepulcre and Adoraci{\'o}n Hern{\'a}ndez-Mart{\'i}nez and J{\'o}se L{\'a}zaro P{\'e}rez-Calle and Bel{\'e}n Beltr{\'a}n and David J. Busquets and Laura Filgueiras Mour{\~a}o Ramos and Fernando Bermejo and Jes{\'u}s Barrio and Manuel Barreiro-de Acosta and O Roncedo and Xavier Calvet and Daniel Herv{\'i}as and Fernando Gomoll{\'o}n and Mercedes Dom{\'i}nguez-Antonaya and Guillermo Alca{\'i}n and Beatriz Sicilia and Carlos Due{\~n}as and Ana Guti{\'e}rrez and Rufo Humberto Lorente-Poyatos and Mariana Y Dom{\'i}nguez and Sam Khorrami and Carlos Taxonera and Antonio Rodr{\'i}guez-P{\'e}rez and {\'A}ngel Ponferrada and Manuel Van Domselaar and Maria Arias-Rivera and Olga Merino and Enrique Sebasti{\'a}n Canseco Castro and Jos{\'e} Miguel Marrero and Mar{\'i}a Dolores Mart{\'i}n-Arranz and Bel{\'e}n Botella and Luis Ignacio Fern{\'a}ndez-Salazar and David Monfort and Ver{\'o}nica Opio and Ana Garc{\'i}a-Herola and Mauricio Menacho and P Ram{\'i}rez-de la Piscina and Daniel Ceballos and Pedro Almela and Merc{\`e} Navarro-Llavat and Virginia Robles-Alonso and Anahi Vega-Lopez and Irene Moraleja and Mar{\'i}a Teresa Novella and Carlos Casta{\~n}o-Milla and Alba S{\'a}nchez-Torres and Jaime M Benitez and C Rodriguez and Liliana Castro and Eddy Garrido and E Dom{\`e}nech and Esther Garc{\'i}a-Planella and Javier P Gisbert}, journal={The American Journal of Gastroenterology}, year={2017}, volume={112}, pages={120-131} }