title: Maintenance of remission among patients with Crohn's disease on antimetabolite therapy after infliximab therapy is stopped.
abstract: OBJECTIVE
  It is important to determine whether infliximab therapy can be safely interrupted in patients with Crohn's disease who have undergone a period of prolonged remission. We assessed the risk of relapse after infliximab therapy was discontinued in patients on combined maintenance therapy with antimetabolites and identified factors associated with relapse.
  
  
  METHODS
  We performed a prospective study of 115 patients with Crohn's disease who were treated for at least 1 year with scheduled infliximab and an antimetabolite and had been in corticosteroid-free remission for at least 6 months. Infliximab was stopped, and patients were followed up for at least 1 year. We associated demographic, clinical, and biologic factors with time to relapse using a Cox model.
  
  
  RESULTS
  After a median follow-up period of 28 months, 52 of the 115 patients experienced a relapse; the 1-year relapse rate was 43.9% ± 5.0%. Based on multivariable analysis, risk factors for relapse included male sex, the absence of surgical resection, leukocyte counts >6.0 × 10(9)/L, and levels of hemoglobin ≤145 g/L, C-reactive protein ≥5.0 mg/L, and fecal calprotectin ≥300 μg/g. Patients with no more than 2 of these risk factors (approximately 29% of the study population) had a 15% risk of relapse within 1 year. Re-treatment with infliximab was effective and well tolerated in 88% of patients who experienced a relapse.
  
  
  CONCLUSIONS
  Approximately 50% of patients with Crohn's disease who were treated for at least 1 year with infliximab and an antimetabolite agent experienced a relapse within 1 year after discontinuation of infliximab. However, patients with a low risk of relapse can be identified using a combination of clinical and biologic markers.
authors.affiliation: Centre Hospitalier Universitaire de Liège, Liège, Belgium. edouard.louis@ulg.ac.be
authors.forename: Edouard
authors.initials: E
authors.lastname: Louis
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mary
authors.forename: Gwenola
authors.initials: G
authors.lastname: Vernier-Massouille
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Grimaud
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.forename: David
authors.initials: D
authors.lastname: Laharie
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Dupas
authors.forename: Hélène
authors.initials: H
authors.lastname: Pillant
authors.forename: Laurence
authors.initials: L
authors.lastname: Picon
authors.forename: Michel
authors.initials: M
authors.lastname: Veyrac
authors.forename: Mathurin
authors.initials: M
authors.lastname: Flamant
authors.forename: Guillaume
authors.initials: G
authors.lastname: Savoye
authors.forename: Raymond
authors.initials: R
authors.lastname: Jian
authors.forename: Martine
authors.initials: M
authors.lastname: Devos
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.forename: Gilles
authors.initials: G
authors.lastname: Paintaud
authors.forename: Eric
authors.initials: E
authors.lastname: Piver
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Colombel
authors.forename: Marc
authors.initials: M
authors.lastname: Lemann
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D000963:Antimetabolites / Q000008:administration & dosage* / Q000009:adverse effects; D001530:Belgium; D015415:Biomarkers / Q000097:blood; D003424:Crohn Disease / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005602:France; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D000069285:Infliximab; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000963:Antimetabolites; D015415:Biomarkers; D005765:Gastrointestinal Agents; D000069285:Infliximab