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Evolution After Anti-TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study.
- Source :
-
The American journal of gastroenterology [Am J Gastroenterol] 2017 Jan; Vol. 112 (1), pp. 120-131. Date of Electronic Publication: 2016 Dec 13. - Publication Year :
- 2017
-
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.<br />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.<br />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.<br />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.
- Subjects :
- Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Colitis, Ulcerative physiopathology
Colon
Constriction, Pathologic
Crohn Disease physiopathology
Disease Progression
Drug-Related Side Effects and Adverse Reactions
Female
Follow-Up Studies
Humans
Ileum
Incidence
Inflammatory Bowel Diseases drug therapy
Male
Mesalamine therapeutic use
Methotrexate therapeutic use
Middle Aged
Proportional Hazards Models
Protective Factors
Recurrence
Remission Induction
Retreatment
Retrospective Studies
Risk Factors
Tumor Necrosis Factor-alpha antagonists & inhibitors
Young Adult
Adalimumab therapeutic use
Antirheumatic Agents therapeutic use
Colitis, Ulcerative drug therapy
Crohn Disease drug therapy
Deprescriptions
Immunologic Factors therapeutic use
Infliximab therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1572-0241
- Volume :
- 112
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The American journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 27958281
- Full Text :
- https://doi.org/10.1038/ajg.2016.569