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

M J Casanova, M Chaparro, V García-Sánchez, O Nantes, E Leo, M Rojas-Feria, A Jauregui-Amezaga, S García-López, J M Huguet, F Arguelles-Arias, M Aicart, I Marín-Jiménez, M Gómez-García, F Muñoz, M Esteve, L Bujanda, X Cortés, J Tosca, J R Pineda, M Mañosa, J Llaó, J Guardiola, I Pérez-Martínez, C Muñoz, Y González-Lama, J Hinojosa, J M Vázquez, M P Martinez-Montiel, G E Rodríguez, R Pajares, M F García-Sepulcre, A Hernández-Martínez, J L Pérez-Calle, B Beltrán, D Busquets, L Ramos, F Bermejo, J Barrio, M Barreiro-de Acosta, O Roncedo, X Calvet, D Hervías, F Gomollón, M Domínguez-Antonaya, G Alcaín, B Sicilia, C Dueñas, A Gutiérrez, R Lorente-Poyatos, M Domínguez, S Khorrami, C Muñoz, C Taxonera, A Rodríguez-Pérez, A Ponferrada, M Van Domselaar, M L Arias-Rivera, O Merino, E Castro, J M Marrero, M Martín-Arranz, B Botella, L Fernández-Salazar, D Monfort, V Opio, A García-Herola, M Menacho, P Ramírez-de la Piscina, D Ceballos, P Almela, M Navarro-Llavat, V Robles-Alonso, A B Vega-López, I Moraleja, M T Novella, C Castaño-Milla, A Sánchez-Torres, J M Benítez, C Rodríguez, L Castro, E Garrido, E Domènech, E García-Planella, J P Gisbert
American Journal of Gastroenterology 2017, 112 (1): 120-131

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.

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