Martin Bortlik1,2, Dana Duricova1,3, Nadezda Machkova1, Veronika Hruba1, Martin Lukas1, Katarina Mitrova1,4, Igor Romanko1, Vladislav Bina5, Karin Malickova6, Martin Kolar7, Milan Lukas1,6. 1. a IBD Clinical and Research Centre, Iscare a.s. , Prague , Czech Republic . 2. b Department of Internal Medicine , Military Hospital, Charles University , Prague , Czech Republic . 3. c Institute of Pharmacology, 1st Medical Faculty, Charles University , Prague , Czech Republic . 4. d Department of Paediatrics , Faculty Hospital Motol, 2nd Medical Faculty, Charles University , Prague , Czech Republic . 5. e Department of Exact Methods , Faculty of Management in Jindřichův Hradec, University of Economics in Prague , Czech Republic . 6. f Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Medical Faculty and General Teaching Hospital, Charles University , Prague , Czech Republic , and. 7. g 1st Medical Faculty, Charles University , Prague , Czech Republic.
Abstract
BACKGROUND: Discontinuation of anti-TNF therapy in patients with inflammatory bowel diseases (IBD) in remission remains a controversial issue. The aims of our study were to assess the proportion of patients who relapse after cessation of biological treatment, and to identify potential risk factors of disease relapse. METHODS: Consecutive IBD patients who discontinued anti-TNF therapy in steroid-free clinical and endoscopic remission were prospectively followed. Multiple logistic regression and Cox proportional-hazards models were used to assess the predictors of disease relapse. RESULTS: Seventy-eight IBD patients (Crohn's disease, CD 61; ulcerative colitis, UC 17) were included and followed for a median of 30 months (range 7-47). A total of 32 (53%) CD patients and nine (53%) UC patients relapsed by the end of the follow-up with a median time to relapse of 8 months (range 1-25) in CD patients and 14 months (range 4-37) in UC patients, respectively. The cumulative probabilities of maintaining remission at 6, 12, and 24 months were 82%, 59%, and 51% in CD patients, and 77%, 77%, and 64% in UC patients, respectively. Survival of CD patients who were in deep remission (clinical and endoscopic healing; faecal calprotectin <150 mg/kg; CRP ≤5 mg/l) was not better compared with those who did not fulfill these criteria. In multivariate models, only colonic CD protected patients from disease relapse. CONCLUSIONS: Approximately half of the IBD patients relapsed within 2 years after anti-TNF discontinuation. In CD patients, no difference between those who were or were not in deep remission was found. Colonic localization protected patients from relapse.
BACKGROUND: Discontinuation of anti-TNF therapy in patients with inflammatory bowel diseases (IBD) in remission remains a controversial issue. The aims of our study were to assess the proportion of patients who relapse after cessation of biological treatment, and to identify potential risk factors of disease relapse. METHODS: Consecutive IBDpatients who discontinued anti-TNF therapy in steroid-free clinical and endoscopic remission were prospectively followed. Multiple logistic regression and Cox proportional-hazards models were used to assess the predictors of disease relapse. RESULTS: Seventy-eight IBDpatients (Crohn's disease, CD 61; ulcerative colitis, UC 17) were included and followed for a median of 30 months (range 7-47). A total of 32 (53%) CDpatients and nine (53%) UC patients relapsed by the end of the follow-up with a median time to relapse of 8 months (range 1-25) in CDpatients and 14 months (range 4-37) in UC patients, respectively. The cumulative probabilities of maintaining remission at 6, 12, and 24 months were 82%, 59%, and 51% in CDpatients, and 77%, 77%, and 64% in UC patients, respectively. Survival of CDpatients who were in deep remission (clinical and endoscopic healing; faecal calprotectin <150 mg/kg; CRP ≤5 mg/l) was not better compared with those who did not fulfill these criteria. In multivariate models, only colonic CD protected patients from disease relapse. CONCLUSIONS: Approximately half of the IBDpatients relapsed within 2 years after anti-TNF discontinuation. In CDpatients, no difference between those who were or were not in deep remission was found. Colonic localization protected patients from relapse.
Authors: Michał Łodyga; Piotr Eder; Magdalena Gawron-Kiszka; Agnieszka Dobrowolska; Maciej Gonciarz; Marek Hartleb; Maria Kłopocka; Ewa Małecka-Wojciesko; Piotr Radwan; Jarosław Reguła; Edyta Zagórowicz; Grażyna Rydzewska Journal: Prz Gastroenterol Date: 2021-11-19
Authors: N A Kennedy; B Warner; E L Johnston; L Flanders; P Hendy; N S Ding; R Harris; A S Fadra; C Basquill; C A Lamb; F L Cameron; C D Murray; M Parkes; I Gooding; T Ahmad; D R Gaya; S Mann; J O Lindsay; J Gordon; J Satsangi; A Hart; S McCartney; P Irving; C W Lees Journal: Aliment Pharmacol Ther Date: 2016-02-19 Impact factor: 8.171
Authors: Ray K Boyapati; Joana Torres; Carolina Palmela; Claire E Parker; Orli M Silverberg; Sonam D Upadhyaya; Tran M Nguyen; Jean-Frédéric Colombel Journal: Cochrane Database Syst Rev Date: 2018-05-12