title: Maintenance of clinical benefit in Crohn's disease patients after discontinuation of infliximab: long-term follow-up of a single centre cohort.
abstract: BACKGROUND
  Tumour necrosis factor-blockade with infliximab has advanced the treatment of Crohn's disease. While infliximab is efficacious, it remains to be determined whether patients who enter clinical remission with an anti-tumour necrosis factor therapy can have their treatment stopped and retain the state of remission.
  
  
  OBJECTIVE
  To assess in patients with Crohn's disease who obtained infliximab-induced remission, the proportion who relapsed after infliximab discontinuation.
  
  
  METHODS
  This longitudinal cohort study examined patients from a University-based IBD referral centre. Forty eight patients with Crohn's disease in full clinical remission and who then discontinued infliximab were followed up for up to 7 years. Crohn's disease relapse was defined as an intervention with Crohn's disease medication or surgery.
  
  
  RESULTS
  Kaplan-Meier analysis of the proportion of patients with sustained clinical benefit demonstrated that 50% relapsed within 477 days after infliximab discontinuance. In contrast, 35% of patients remained well, and without clinical relapse, up to the end of the nearly 7-year follow-up.
  
  
  CONCLUSIONS
  In patients with Crohn's disease with an infliximab-induced remission, stopping infliximab results in a predictable relapse in a majority of patients. Nevertheless, a small percentage of patients sustain a long-term remission.
authors.affiliation: Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada.
authors.forename: A W G
authors.initials: AW
authors.lastname: Waugh
authors.forename: S
authors.initials: S
authors.lastname: Garg
authors.forename: K
authors.initials: K
authors.lastname: Matic
authors.forename: L
authors.initials: L
authors.lastname: Gramlich
authors.forename: C
authors.initials: C
authors.lastname: Wong
authors.forename: D C
authors.initials: DC
authors.lastname: Sadowski
authors.forename: M
authors.initials: M
authors.lastname: Millan
authors.forename: R
authors.initials: R
authors.lastname: Bailey
authors.forename: D
authors.initials: D
authors.lastname: Todoruk
authors.forename: R
authors.initials: R
authors.lastname: Cherry
authors.forename: C W
authors.initials: CW
authors.lastname: Teshima
authors.forename: L
authors.initials: L
authors.lastname: Dieleman
authors.forename: R N
authors.initials: RN
authors.lastname: Fedorak
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D015331:Cohort Studies; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D008137:Longitudinal Studies; D008297:Male; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab