Pauliina Molander1, Martti Färkkilä, Kimmo Salminen, Helena Kemppainen, Timo Blomster, Ritva Koskela, Airi Jussila, Henna Rautiainen, Markku Nissinen, Johanna Haapamäki, Perttu Arkkila, Urpo Nieminen, Juha Kuisma, Jari Punkkinen, Kaija-Leena Kolho, Harri Mustonen, Taina Sipponen. 1. *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.
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.
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: M J Casanova; M Chaparro; V García-Sánchez; O Nantes; E Leo; M Rojas-Feria; A Jauregui-Amezaga; S García-López; J M Huguet; F Arguelles-Arias; M Aicart; I Marín-Jiménez; M Gómez-García; F Muñoz; M Esteve; L Bujanda; X Cortés; J Tosca; J R Pineda; M Mañosa; J Llaó; J Guardiola; I Pérez-Martínez; C Muñoz; Y González-Lama; J Hinojosa; J M Vázquez; M P Martinez-Montiel; G E Rodríguez; R Pajares; M F García-Sepulcre; A Hernández-Martínez; J L Pérez-Calle; B Beltrán; D Busquets; L Ramos; F Bermejo; J Barrio; M Barreiro-de Acosta; O Roncedo; X Calvet; D Hervías; F Gomollón; M Domínguez-Antonaya; G Alcaín; B Sicilia; C Dueñas; A Gutiérrez; R Lorente-Poyatos; M Domínguez; S Khorrami; C Muñoz; C Taxonera; A Rodríguez-Pérez; A Ponferrada; M Van Domselaar; M L Arias-Rivera; O Merino; E Castro; J M Marrero; M Martín-Arranz; B Botella; L Fernández-Salazar; D Monfort; V Opio; A García-Herola; M Menacho; P Ramírez-de la Piscina; D Ceballos; P Almela; M Navarro-Llavat; V Robles-Alonso; A B Vega-López; I Moraleja; M T Novella; C Castaño-Milla; A Sánchez-Torres; J M Benítez; C Rodríguez; L Castro; E Garrido; E Domènech; E García-Planella; J P Gisbert Journal: Am J Gastroenterol Date: 2016-12-13 Impact factor: 10.864