Javier P Gisbert1, Alicia C Marín1, María Chaparro1. 1. Gastroenterology Unit, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Abstract
OBJECTIVES: To perform a meta-analysis of the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) therapy in patients with Crohn's disease (CD) and ulcerative colitis (UC), to evaluate risk factors for relapse, and to assess the response to retreatment with the same anti-TNF. METHODS: Studies evaluating the incidence of relapse after anti-TNF discontinuation in patients with CD or UC who reached clinical remission with anti-TNFs were included. Bibliographies up to January 2015 were searched. Frequency of relapse after discontinuation of anti-TNF agents was determined; meta-analyses were performed using the inverse-variance method. RESULTS: We included 27 studies (21 infliximab and 6 infliximab/adalimumab). The overall risk of relapse after discontinuation of anti-TNF therapy was 44% for CD (95% confidence interval (CI) 36-51%; I(2)=79%; 912 patients) and 38% for UC (23-52%; I(2)=82%; 266 patients). In CD, the relapse rate was 38% at 6 months after discontinuation (short term), 40% at 12 months (medium term), and 49% at >25 months (long term). In UC, 28% of patients relapsed at 12 months. In CD, when clinical remission was the only criterion for stopping anti-TNF therapy, the relapse rate after 1 year was 42%, which decreased to 26% when endoscopic remission was also required. Retreatment with the same anti-TNF induced remission again in 80% of cases (68-91%). CONCLUSIONS: Approximately one-third of patients with inflammatory bowel disease in remission under anti-TNF treatment relapsed 1 year after discontinuation. This proportion increased to half in the long term. In CD patients, the risk of relapse was lower when the criterion for discontinuation was endoscopic remission and not only clinical remission. Response to retreatment with the same anti-TNF agent was favorable.
OBJECTIVES: To perform a meta-analysis of the risk of relapse after discontinuation of anti-tumornecrosis factor (anti-TNF) therapy in patients with Crohn's disease (CD) and ulcerative colitis (UC), to evaluate risk factors for relapse, and to assess the response to retreatment with the same anti-TNF. METHODS: Studies evaluating the incidence of relapse after anti-TNF discontinuation in patients with CD or UC who reached clinical remission with anti-TNFs were included. Bibliographies up to January 2015 were searched. Frequency of relapse after discontinuation of anti-TNF agents was determined; meta-analyses were performed using the inverse-variance method. RESULTS: We included 27 studies (21 infliximab and 6 infliximab/adalimumab). The overall risk of relapse after discontinuation of anti-TNF therapy was 44% for CD (95% confidence interval (CI) 36-51%; I(2)=79%; 912 patients) and 38% for UC (23-52%; I(2)=82%; 266 patients). In CD, the relapse rate was 38% at 6 months after discontinuation (short term), 40% at 12 months (medium term), and 49% at >25 months (long term). In UC, 28% of patients relapsed at 12 months. In CD, when clinical remission was the only criterion for stopping anti-TNF therapy, the relapse rate after 1 year was 42%, which decreased to 26% when endoscopic remission was also required. Retreatment with the same anti-TNF induced remission again in 80% of cases (68-91%). CONCLUSIONS: Approximately one-third of patients with inflammatory bowel disease in remission under anti-TNF treatment relapsed 1 year after discontinuation. This proportion increased to half in the long term. In CDpatients, the risk of relapse was lower when the criterion for discontinuation was endoscopic remission and not only clinical remission. Response to retreatment with the same anti-TNF agent was favorable.
Authors: Richard J Farrell; Mazen Alsahli; Yoon-Tae Jeen; Kenneth R Falchuk; Mark A Peppercorn; Pierre Michetti Journal: Gastroenterology Date: 2003-04 Impact factor: 22.682
Authors: Alessandro Armuzzi; Gert Van Assche; Walter Reinisch; Guillaume Pineton de Chambrun; Anne Griffiths; Malgorzata Sladek; Jan C Preiss; Milan Lukas; Geert D'Haens Journal: J Crohns Colitis Date: 2012-03-09 Impact factor: 9.071
Authors: Casper Steenholdt; Akbar Molazahi; Mark Andrew Ainsworth; Jørn Brynskov; Ole Østergaard Thomsen; Jakob Benedict Seidelin Journal: Scand J Gastroenterol Date: 2012-03-01 Impact factor: 2.423
Authors: Pauliina Molander; 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 Journal: Inflamm Bowel Dis Date: 2014-06 Impact factor: 5.325
Authors: Konstantinos Papamichael; Niels Vande Casteele; Ann Gils; Sophie Tops; Scott Hauenstein; Sharat Singh; Fred Princen; Gert Van Assche; Paul Rutgeerts; Severine Vermeire; Marc Ferrante Journal: Clin Gastroenterol Hepatol Date: 2014-12-03 Impact factor: 11.382
Authors: Mark A Quinn; Philip G Conaghan; Philip J O'Connor; Zunaid Karim; Adam Greenstein; Andrew Brown; Clare Brown; Alexander Fraser; Stephen Jarret; Paul Emery Journal: Arthritis Rheum Date: 2005-01
Authors: S Ardizzone; E Colombo; G Maconi; S Bollani; G Manzionna; M C Petrone; G Bianchi Porro Journal: Dig Liver Dis Date: 2002-06 Impact factor: 4.088
Authors: Eric D Shah; Elliot S Coburn; Anil Nayyar; Kerry Jo Lee; Jenna L Koliani-Pace; Corey A Siegel Journal: Aliment Pharmacol Ther Date: 2020-01-28 Impact factor: 8.171
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: 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
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