1. Evolution After Anti-TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study
- Author
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Casanova MJ, Chaparro M, García-Sánchez V, Nantes O, Leo E, Rojas-Feria M, Jauregui-Amezaga A, García-López S, Huguet JM, Arguelles-Arias F, Aicart M, Marín-Jiménez I, Gómez-García M, Muñoz F, Esteve M, Bujanda L, Cortés X, Tosca J, Pineda JR, Mañosa M, Llaó J, Guardiola J, Pérez-Martínez I, Muñoz C, González-Lama Y, Hinojosa J, Vázquez JM, Martinez-Montiel MP, Rodríguez GE, Pajares R, García-Sepulcre MF, Hernández-Martínez A, Pérez-Calle JL, Beltrán B, Busquets D, Ramos L, Bermejo F, Barrio J, Barreiro-de Acosta M, Roncedo O, Calvet X, Hervías D, Gomollón F, Domínguez-Antonaya M, Alcaín G, Sicilia B, Dueñas C, Gutiérrez A, Lorente-Poyatos R, Domínguez M, Khorrami S, Taxonera C, Rodríguez-Pérez A, Ponferrada A, Van Domselaar M, Arias-Rivera ML, Merino O, Castro E, Marrero JM, Martín-Arranz M, Botella B, Fernández-Salazar L, Monfort D, Opio V, García-Herola A, Menacho M, Ramírez-de la Piscina P, Ceballos D, Almela P, Navarro-Llavat M, Robles-Alonso V, Vega-López AB, Moraleja I, Novella MT, Castaño-Milla C, Sánchez-Torres A, Benítez JM, Rodríguez C, Castro L, Garrido E, Domènech E, García-Planella E, and Gisbert JP
- Subjects
Male ,Constriction, Pathologic ,Inflammatory bowel disease ,Gastroenterology ,Deprescriptions ,0302 clinical medicine ,Crohn Disease ,Recurrence ,Risk Factors ,Medicine ,Young adult ,Mesalamine ,Aged, 80 and over ,Incidence ,Incidence (epidemiology) ,Remission Induction ,Age Factors ,Middle Aged ,Antirheumatic Agents ,030220 oncology & carcinogenesis ,Retreatment ,Disease Progression ,Female ,030211 gastroenterology & hepatology ,Tumor necrosis factor alpha ,Adult ,medicine.medical_specialty ,Adolescent ,Drug-Related Side Effects and Adverse Reactions ,Colon ,Young Adult ,03 medical and health sciences ,Ileum ,Internal medicine ,Humans ,Immunologic Factors ,Colitis ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Hepatology ,Tumor Necrosis Factor-alpha ,business.industry ,Proportional hazards model ,Adalimumab ,Retrospective cohort study ,Protective Factors ,Inflammatory Bowel Diseases ,medicine.disease ,Infliximab ,Discontinuation ,Methotrexate ,Colitis, Ulcerative ,business ,Follow-Up Studies - 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% confi dence 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 infl ammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identifi ed. Retreatment with the same anti-TNF drug was effective and safe.
- Published
- 2017