학술논문
Evolution After Anti-TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study
Document Type
Article
Author
Casanova, M J; Chaparro, M; García-Sánchez, V; Nantes, O; Leo, E; Rojas-Feria, M; Jauregui-Amezaga, A; García-López, S; Huguet, J M; Arguelles-Arias, F; Aicart, M; Marín-Jiménez, I; Gómez-García, M; Muñoz, F; Esteve, M; Bujanda, L; Cortés, X; Tosca, J; Pineda, J R; Mañosa, M; Llaó, J; Guardiola, J; Pérez-Martínez, I; Muñoz, C; González-Lama, Y; Hinojosa, J; Vázquez, J M; Martinez-Montiel, M P; Rodríguez, G E; Pajares, R; García-Sepulcre, M F; Hernández-Martínez, A; Pérez-Calle, J L; 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; Muñoz, C; Taxonera, C; Rodríguez-Pérez, A; Ponferrada, A; Van Domselaar, M; Arias-Rivera, M L; Merino, O; Castro, E; Marrero, J M; 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, A B; Moraleja, I; Novella, M T; Castaño-Milla, C; Sánchez-Torres, A; Benítez, J M; Rodríguez, C; Castro, L; Garrido, E; Domènech, E; García-Planella, E; Gisbert, J P
Source
The American Journal of Gastroenterology: Official Publication of the National Gastroenterological Association; January 2017, Vol. 112 Issue: 1 p120-131, 12p
Subject
Language
ISSN
00029270; 15720241
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.