title: Infliximab as a bridge to remission maintained by antimetabolite therapy in Crohn's disease: A retrospective study.
abstract: BACKGROUND
  Infliximab withdrawal in patients with Crohn's disease on concomitant antimetabolite therapy is considered to be superior if obtained after a maintenance therapy period compared to induction alone.
  
  
  METHODS
  We retrospectively analyzed the outcome of Crohn's disease patients treated with infliximab and an antimetabolite after infliximab was withdrawn using induction alone or induction plus at least 1-year of maintenance therapy. The time to relapse was analyzed using univariate and multivariate analyses. The model was adjusted according to the period of infliximab withdrawal.
  
  
  RESULTS
  A total of 92 patients were included, 54 in the induction alone group. The patient characteristics were identical in the two groups except for the period of infliximab withdrawal. After a median follow-up period of 47.1 (interquartile range=4.4-110.2) months, 66 patients (72%) experienced a relapse. After a year-adjustment, no significant difference was observed between the two groups. Based on year-adjusted multivariate analysis, the risk factors for relapse were active smoking, previous antimetabolite failure, and perianal disease. After relapse, 53 patients (80%) were retreated with infliximab. After infliximab retreatment, clinical remission was observed in 47 patients (89%) at weeks 8-10.
  
  
  CONCLUSIONS
  In Crohn's disease patients, the probability of relapse on antimetabolite therapy after infliximab withdrawal was not superior after a 1-year scheduled maintenance therapy as compared with an induction alone.
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Paris Est Creteil University (UPEC), Henri Mondor Hospital, Department of Gastroenterology, Creteil, France.
authors.forename: Armelle
authors.initials: A
authors.lastname: Chauvin
authors.affiliation: Paris Est Creteil University (UPEC), Laboratory of Clinical Investigation (LIC, EA 4393), Creteil, France; Assistance Publique-Hôpitaux de Paris (APHP), Henri Mondor Hospital, Department of Public Health, Creteil, France; Assistance Publique-Hôpitaux de Paris (APHP), Henri Mondor Hospital, Clinical Research Unit (URC Mondor), Creteil, France.
authors.forename: Aurelie
authors.initials: A
authors.lastname: Le Thuaut
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Paris Est Creteil University (UPEC), Henri Mondor Hospital, Department of Gastroenterology, Creteil, France.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Belhassan
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Paris Est Creteil University (UPEC), Henri Mondor Hospital, Department of Gastroenterology, Creteil, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Le Baleur
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Paris Est Creteil University (UPEC), Henri Mondor Hospital, Department of Gastroenterology, Creteil, France.
authors.forename: Farida
authors.initials: F
authors.lastname: Mesli
authors.affiliation: Paris Est Creteil University (UPEC), Laboratory of Clinical Investigation (LIC, EA 4393), Creteil, France; Assistance Publique-Hôpitaux de Paris (APHP), Henri Mondor Hospital, Department of Public Health, Creteil, France; Assistance Publique-Hôpitaux de Paris (APHP), Henri Mondor Hospital, Clinical Research Unit (URC Mondor), Creteil, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bastuji-Garin
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Paris Est Creteil University (UPEC), Henri Mondor Hospital, Department of Gastroenterology, Creteil, France.
authors.forename: Jean Charles
authors.initials: JC
authors.lastname: Delchier
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Paris Est Creteil University (UPEC), Henri Mondor Hospital, Department of Gastroenterology, Creteil, France; Paris Est Creteil University (UPEC), Laboratory of Clinical Investigation (LIC, EA 4393), Creteil, France. Electronic address: aurelien.amiot@hmn.aphp.fr.
authors.forename: Aurelien
authors.initials: A
authors.lastname: Amiot
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D000963:Antimetabolites / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D060046:Maintenance Chemotherapy; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D012008:Recurrence; D012074:Remission Induction; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D000963:Antimetabolites; D000069285:Infliximab; D015122:Mercaptopurine; D001379:Azathioprine; D008727:Methotrexate
keywords: Crohn's disease; IBD; Inflammatory bowel disease; Infliximab withdrawal