title: Relapse rates of inflammatory bowel disease patients in deep and clinical remission after discontinuing anti-tumor necrosis factor alpha therapy.
abstract: OBJECTIVE
  Relapse rates after discontinuing anti-tumor necrosis factor-α (TNFα) therapy of inflammatory bowel disease (IBD) patients in deep remission are poorly understood. This prospective single-center open-label study evaluated the relapse rates of IBD patients after stopping anti-TNFα therapy.
  
  
  METHODS
  All IBD patients who were in clinical remission and stopped anti-TNFα therapy in 2011-2013 and were followed up for at least 12 months were enrolled. The "Ultradeep" patients were in calprotectin-negative (<50 ng/g) deep remission for at least six months and ceased anti-TNFα therapy on physician recommendations. The "clinical" patients were in clinical but not deep remission and ceased anti-TNFα therapy for other reasons. Relapse rates were assessed and relapse risk factors identified.
  
  
  RESULTS
  One year after stopping, 27 % and 27 % of the Ultradeep (n = 11) and Clinical (n = 11) patients relapsed, respectively. Two years after stopping, 57 % and 62 % relapsed, respectively (p = 0.89). All relapsed patients who underwent retreatment with anti-TNFα therapy re-entered remission. Male sex was a significant risk factor for relapse (p = 0.03).
  
  
  CONCLUSIONS
  Our study showed that even highly selected IBD patients who lack clinical, endoscopic or laboratory signs of disease activity have a relatively high relapse rate in the follow-up period after ceasing anti-TNFα therapy (Tab. 2, Fig. 3, Ref. 24).
authors.forename: T
authors.initials: T
authors.lastname: Hlavaty
authors.forename: A
authors.initials: A
authors.lastname: Krajcovicova
authors.forename: J
authors.initials: J
authors.lastname: Letkovsky
authors.forename: I
authors.initials: I
authors.lastname: Sturdik
authors.forename: T
authors.initials: T
authors.lastname: Koller
authors.forename: J
authors.initials: J
authors.lastname: Toth
authors.forename: M
authors.initials: M
authors.lastname: Huorka
mesh_terms: D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D003424:Crohn Disease / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage / Q000009:adverse effects; D039841:Leukocyte L1 Antigen Complex / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D028761:Withholding Treatment / Q000706:statistics & numerical data
chemical_list: D005765:Gastrointestinal Agents; D039841:Leukocyte L1 Antigen Complex; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
keywords: Crohn's disease; adalimumab; infliximab; relapse rate.; treatment discontinuation; ulcerative colitis