title: [Clinical outcome after discontinuation of infliximab in patients with ulcerative colitis in deep remission].
abstract: BACKGROUND
  Infliximab (IFX) is effective in treating ulcerative colitis (UC) and in achieving mucosal healing (MH). Little is known about the role of mucosal healing (MH) in the subsequent evolution of the disease and the consequences of discontinuing treatment.
  
  
  OBJECTIVE
  To evaluate the characteristics and evolution of patients with UC treated with IFX who discontinued treatment after disease remission.
  
  
  METHODS
  Observational, prospective study of patients with moderate to severe UC, corticosteroid-resistant/corticosteroid-dependent, naïve to anti-TNF. IFX administration regimen: 5 mg/kg at 0-2-6 weeks and every 8 weeks thereafter until week 54. In patients achieving MH, IFX was discontinued and the patients were followed-up for at least 20 months. Clinical remission (CR): mayo score <2; Clinical response: decrease in mayo score of 3 points; MH: mayo score 0-1; Deep remission: patient with CR and MH.
  
  
  RESULTS
  Of the 21 patients enrolled, 19 completed the study (colectomy, n = 1; non-responder, n = 1). Mean age: 47.8 years. UC: severe (n = 13) and moderate (n = 6); most patients (n = 11) were steroid-resistant; 57.8% received combined treatment with immunosuppressants, and 31.5% intensified treatment. Week 54: 16 patients (84.2%) showed clinical response, 13 (68.4%) showed CR, and 12 (63.2%) deep remission. Of these, 6 (25%) presented a new episode of UC, and in 3 (25%) IFX was restarted within 12 weeks of discontinuation, with all patients responding. Of the total sample, 91.7% remained IFX-free at week 8, and 75% at week 12, with no remission during follow-up. None of the patients required hospitalization or surgery.
  
  
  CONCLUSIONS
  Half of patients with deep remission of UC with IFX therapy presented a new episode after treatment discontinuation, and in 25% IFX therapy was restarted.
authors.affiliation: Servicio de Digestivo, Hospital Universitario de Basurto, Bilbao, España. Electronic address: antxonirigoyen@telefonica.net.
authors.forename: Carmen
authors.initials: C
authors.lastname: Muñoz Villafranca
authors.affiliation: Servicio de Digestivo, Hospital Universitario de Basurto, Bilbao, España.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Bravo Rodríguez
authors.affiliation: Servicio de Digestivo, Hospital Universitario de Basurto, Bilbao, España.
authors.forename: Jone
authors.initials: J
authors.lastname: Ortiz de Zárate
authors.affiliation: Servicio de Digestivo, Hospital Universitario de Basurto, Bilbao, España.
authors.forename: Paz
authors.initials: P
authors.lastname: Arreba González
authors.affiliation: Servicio de Digestivo, Hospital Universitario de Basurto, Bilbao, España.
authors.forename: Iñigo
authors.initials: I
authors.lastname: García Kamiruaga
authors.affiliation: Servicio de Digestivo, Hospital Universitario de Basurto, Bilbao, España.
authors.forename: Juan Ignacio
authors.initials: JI
authors.lastname: Heras Martín
authors.affiliation: Servicio de Digestivo, Hospital Universitario de Basurto, Bilbao, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: Cabezudo Gil
authors.affiliation: Servicio de Digestivo, Hospital Universitario de Basurto, Bilbao, España.
authors.forename: Víctor
authors.initials: V
authors.lastname: Orive Cura
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001691:Biological Therapy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000503:physiopathology; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D012720:Severity of Illness Index; D028761:Withholding Treatment
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D000069285:Infliximab
keywords: Colitis ulcerosa; Curación mucosa; Deep remission; Infliximab; Interrupción del tratamiento; Mucosal healing; Remisión profunda; Treatment discontinuation; Ulcerative colitis