title: Outcome after discontinuation of infliximab in patients with inflammatory bowel disease in clinical remission: an observational Danish single center study.
abstract: OBJECTIVE
  To investigate duration of remission, including risk factors for relapse and response to retreatment with infliximab (IFX), in patients with Crohn's disease (CD) and ulcerative colitis (UC) who had discontinued IFX while in clinical remission.
  
  
  METHODS
  Observational, single-center, retrospective study of all patients with a primary response to IFX who discontinued IFX therapy while in steroid-free remission. Relapse was defined as reintroduction of treatment with a biologic, systemic steroid or surgery.
  
  
  RESULTS
  Of 219, 53 (24%) CD patients, and 28 of 97 (30%) UC patients discontinued IFX while in clinical steroid-free remission. The proportion of patients in remission declined steadily with 61% of CD patients, and 75% of UC patients being in remission after 1 year. Half the patients maintained remission after median 2 years (680 days (412-948)) and 3.5 years (1334 days (995-1673)), respectively; p = 0.057. Twelve percent with CD and 40% with UC were in remission at the end of follow-up after 10 and 4.5 years, respectively. Longer disease duration was associated with relapse in univariate analysis in CD, OR 1.1 (1.0-1.1), p = 0.022. Of 25, 24 CD patients (96%), and 5 of 7 UC patients (71%) experienced complete clinical remission when retreated with IFX after relapse.
  
  
  CONCLUSIONS
  While the short-term prognosis seems favorable, the majority of patients who discontinue IFX while in remission relapse over time. The response to retreatment with IFX at relapse seems favorable in this subpopulation.
authors.affiliation: Dept of Gastroenterology, Herlev Hospital, Denmark. steenholdt@brygge.dk
authors.forename: Casper
authors.initials: C
authors.lastname: Steenholdt
authors.forename: Akbar
authors.initials: A
authors.lastname: Molazahi
authors.forename: Mark Andrew
authors.initials: MA
authors.lastname: Ainsworth
authors.forename: Jørn
authors.initials: J
authors.lastname: Brynskov
authors.forename: Ole
authors.initials: O
authors.lastname: Østergaard Thomsen
authors.forename: Jakob Benedict
authors.initials: JB
authors.lastname: Seidelin
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D016001:Confidence Intervals; D003424:Crohn Disease / Q000188:drug therapy*; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D053208:Kaplan-Meier Estimate; D008297:Male; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab