Long-term outcome of inflammatory bowel disease patients with deep remission after discontinuation of TNFα-blocking agents.
BACKGROUND
Little data exist on the long-term prognosis of patients with inflammatory bowel disease (IBD) after stopping TNFα-blocking therapy in deep remission. Existing data indicate that approximately 50% of patients on combination therapy who discontinued TNFα-blockers are still in remission 24 months later. The aims of this follow-up analysis were to evaluate the long-term remission rate after cessation of TNFα-blocking therapy, the predicting factors of a relapse and the response to restarting TNFα blockers.


METHODS
The first follow-up data of 51 IBD patients (17 Crohn's disease [CD], 30 ulcerative colitis [UC] and four inflammatory bowel disease type unclassified [IBDU]) in deep remission at the time of cessation of TNFα-blocking therapy have been published earlier. The long-term data was collected retrospectively after the first follow-up year to evaluate the remission rate and risk factors for the relapse after a median of 36 months.


RESULTS
After the first relapse-free year, 14 out of the remaining 34 IBD patients relapsed (41%; 5/12 [42%] CD and 9/22 [41%] UC/IBDU). Univariate analysis indicated no associations with any predictive factors. Re-treatment was effective in 90% (26/29) of patients.


CONCLUSIONS
Of IBD patients in deep remission at the time of cessation of TNFα-blocking therapy, up to 60% experience a clinical or endoscopic relapse after a median follow-up time of 36 months (95% CI 31-41 months). No individual risk factors predicting relapse could be identified. However, the initial response to a restart of TNFα-blockers seems to be effective and well tolerated.
a Department of Gastroenterology , Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland.
Pauliina
P
Molander
a Department of Gastroenterology , Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland.
Martti
M
Färkkilä
b Turku University Central Hospital , Turku , Finland.
Helena
H
Kemppainen
c Oulu University Central Hospital , Oulu , Finland.
Timo
T
Blomster
d Department of Gastroenterology and Alimentary Tract Surgery , Tampere University Hospital , Tampere , Finland.
Airi
A
Jussila
e Department of Surgery , Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland.
Harri
H
Mustonen
a Department of Gastroenterology , Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland.
Taina
T
Sipponen
D000068879:Adalimumab / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000145:classification / Q000188:drug therapy*; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
Crohn’s disease; TNFα-antagonist; adalimumab; infliximab; relapse; stopping; ulcerative colitis