title: Outcome after discontinuation of TNFα-blocking therapy in patients with inflammatory bowel disease in deep remission.
abstract: BACKGROUND
  Few data are available on the disease course in patients with inflammatory bowel disease (IBD) in deep remission after discontinuing tumor necrosis factor α (TNFα)-blocking therapy. In this prospective multicenter study, we evaluated the relapse rate, predictive factors, and the response to retreatment after discontinuation of TNFα-blocking therapy in patients with IBD in deep remission.
  
  
  METHODS
  We recruited 52 patients (17 Crohn's disease, 30 ulcerative colitis, and 5 IBD unclassified) in clinical, endoscopic, and fecal calprotectin-based (<100 μg/g) remission after at least 1 year of TNFα-blocking therapy. Clinical and endoscopic remission and relapse were defined according to validated indices. After discontinuation of therapy, the patients were followed up with endoscopic assessment at 4 and 12 months. In the event of a clinical relapse with endoscopically active disease or minor clinical symptoms but severe endoscopic relapse, TNFα-blocking therapy was restarted.
  
  
  RESULTS
  After a median follow-up time of 13 (range, 12-15) months, 17/51 (33%) patients relapsed (5/17 Crohn's disease, 12/34 ulcerative colitis/IBD unclassified, 1 patient lost to follow-up at 6 mo). Ten experienced clinical and endoscopic relapse, 5 clinical relapse with mild endoscopic activity, and 2 severe endoscopic relapse. No specific predictive factors were associated with the relapse. Retreatment was effective in 94% of patients.
  
  
  CONCLUSIONS
  After cessation of TNFα-blocking therapy in patients with IBD in deep remission, up to 67% remained in clinical remission during the 12-month follow-up. Importantly, 85% of these patients sustained endoscopic remission. The response to restart of TNFα antagonists was effective and well tolerated.
authors.affiliation: *Department of Medicine, Division of Gastroenterology, Maria Helsinki City Hospital and University of Helsinki, Helsinki, Finland; †Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland; ‡Division of Gastroenterology, Department of Medicine, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland; §Department of Medicine, Division of Gastroenterology, Turku University Central Hospital, Turku, Finland; ‖Department of Medicine, Division of Gastroenterology, Oulu University Central Hospital, Oulu, Finland; ¶Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; **Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland; ††Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Peijas Hospital, Vantaa, Finland; ‡‡Department of Medicine, Hyvinkää Hospital, Hyvinkää, Finland; §§Department of Medicine, Porvoo Hospital, Porvoo, Finland; ‖‖Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland; and ¶¶Department of Surgery, Helsinki University Central Hospital, Biomedicum Helsinki, Finland.
authors.forename: Pauliina
authors.initials: P
authors.lastname: Molander
authors.forename: Martti
authors.initials: M
authors.lastname: Färkkilä
authors.forename: Kimmo
authors.initials: K
authors.lastname: Salminen
authors.forename: Helena
authors.initials: H
authors.lastname: Kemppainen
authors.forename: Timo
authors.initials: T
authors.lastname: Blomster
authors.forename: Ritva
authors.initials: R
authors.lastname: Koskela
authors.forename: Airi
authors.initials: A
authors.lastname: Jussila
authors.forename: Henna
authors.initials: H
authors.lastname: Rautiainen
authors.forename: Markku
authors.initials: M
authors.lastname: Nissinen
authors.forename: Johanna
authors.initials: J
authors.lastname: Haapamäki
authors.forename: Perttu
authors.initials: P
authors.lastname: Arkkila
authors.forename: Urpo
authors.initials: U
authors.lastname: Nieminen
authors.forename: Juha
authors.initials: J
authors.lastname: Kuisma
authors.forename: Jari
authors.initials: J
authors.lastname: Punkkinen
authors.forename: Kaija-Leena
authors.initials: KL
authors.lastname: Kolho
authors.forename: Harri
authors.initials: H
authors.lastname: Mustonen
authors.forename: Taina
authors.initials: T
authors.lastname: Sipponen
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005243:Feces / Q000737:chemistry; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D000069285:Infliximab; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D018570:Risk Assessment; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D039841:Leukocyte L1 Antigen Complex; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab