title: Achievement of deep remission during scheduled maintenance therapy with TNFα-blocking agents in IBD.
abstract: OBJECTIVE
  Deep remission, meaning clinical remission with mucosal healing (MH), with anti-tumor necrosis factor-alpha (TNF-α) agents is a new target for therapy in inflammatory bowel disease (IBD). Our aim was to study how often patients on TNF-α blocking therapy actually achieve deep remission.
  
  
  METHODS
  The total of 252 IBD patients retrospectively included (183 Crohn's disease (CD), 62 ulcerative colitis (CU) or 7 inflammatory bowel disease unclassified-type colitis (IBDU)) received TNFα-antagonists (177 infliximab, 75 adalimumab) for at least 11 months and underwent ileocolonoscopy. We reviewed endoscopic and histological findings, clinical symptoms, C-reactive protein (CRP), and fecal calprotectin (FC) levels, and data on TNF-α blocking therapy. Defining deep remission as no clinical symptoms with endoscopic remission (the simple endoscopic score for Crohn's disease, SES-CD 0-2 or Mayo endoscopic subscore 0-1).
  
  
  RESULTS
  Of the 252 patients, 168 (67%) were in clinical remission and 122 (48%) in deep remission after a median of 23 months of maintenance therapy. Of the 183 CD patients, 117 (64%) reached clinical remission and 79 (43%) deep remission. Of the UC patients, 52 (75%) were in clinical remission and 43 (62%) in deep remission. The majority of patients in deep remission (n=99, 81%) also had histologically inactive disease. Both median CRP and FC levels were significantly lower in patients with deep remission.
  
  
  CONCLUSIONS
  Reassuringly, half of the IBD patients on the TNFα-blocking maintenance therapy achieved deep remission. The majority of patients in deep remission also achieved histological remission.
authors.affiliation: Maria Helsinki City Hospital, Helsinki, Finland. pauliina.molander@welho.com
authors.forename: Pauliina
authors.initials: P
authors.lastname: Molander
authors.forename: Taina
authors.initials: T
authors.lastname: Sipponen
authors.forename: Helena
authors.initials: H
authors.lastname: Kemppainen
authors.forename: Airi
authors.initials: A
authors.lastname: Jussila
authors.forename: Timo
authors.initials: T
authors.lastname: Blomster
authors.forename: Ritva
authors.initials: R
authors.lastname: Koskela
authors.forename: Markku
authors.initials: M
authors.lastname: Nissinen
authors.forename: Henna
authors.initials: H
authors.lastname: Rautiainen
authors.forename: Juha
authors.initials: J
authors.lastname: Kuisma
authors.forename: Kaija-Leena
authors.initials: KL
authors.lastname: Kolho
authors.forename: Martti
authors.initials: M
authors.lastname: Färkkilä
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology*; D003113:Colonoscopy; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology*; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D039841:Leukocyte L1 Antigen Complex; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000069285:Infliximab; D000068879:Adalimumab