Gionata Fiorino1, Pablo Navarro Cortes2, Pierre Ellul3, Carla Felice4, Pantelis Karatzas5, Marco Silva6, Peter L Lakatos7, Fabrizio Bossa8, Bella Ungar9, Shaji Sebastian10, Federica Furfaro11, Konstantinos Karmiris12, Konstantinos H Katsanos13, Martina Muscat3, Dimitrios K Christodoulou13, Giovanni Maconi14, Uri Kopylov9, Fernando Magro15, Gerassimos J Mantzaris5, Alessandro Armuzzi4, Marta Maia Boscà-Watts2, Shomron Ben-Horin9, Stefanos Bonovas11, Silvio Danese16. 1. Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy. Electronic address: gionataf@gmail.com. 2. Inflammatory Bowel Disease Unit, Department of Gastroenterology, University Clinic Hospital, Valencia, Spain. 3. Division of Gastroenterology, Mater Dei Hospital, Msida, Malta. 4. Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Gemelli Hospital Catholic University, Rome, Italy. 5. Department of Gastroenterology, Evangelismos Hospital, Athens, Greece. 6. Department of Gastroenterology, Hospital de São João, Porto, Portugal. 7. Semmelweiss University, 1st Department of Internal Medicine, Budapest, Hungary. 8. Unità di Gastroenterologia ed Endoscopia Digestiva, Ospedale Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico San Giovanni Rotondo (FG), Italy. 9. Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel. 10. Inflammatory Bowel Disease Unit, Hull and East Yorkshire National Health Service Trust, Hull, United Kingdom. 11. Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy. 12. Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece. 13. Division of Gastroenterology, School of Health Sciences, University of Ioannina, Greece. 14. Division of Gastroenterology, Department of Biomedical and Clinical Sciences, Luigi Sacco University Hospital, Milan, Italy. 15. Department of Gastroenterology, Hospital de São João, Porto, Portugal; Department of Pharmacology and Therapeutics, Porto Medical School, Porto, Portugal. 16. Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
Abstract
BACKGROUND & AIMS: Infliximab is a safe and effective therapy for ulcerative colitis (UC). We conducted a multicenter retrospective cohort study that included 7 European countries and Israel to examine whether infliximab discontinuation can be considered for patients who achieve sustained remission. METHODS: We performed a retrospective cohort study, collecting medical records from 13 tertiary care referral inflammatory bowel disease centers of all patients with UC treated with infliximab (n = 193). We compared the disease course of patients with at least 12 months of clinical remission who discontinued infliximab (n = 111) with that of patients who continued scheduled treatment (controls, n = 82). We examined the incidence rates of relapse, hospitalization and colectomy, the comparative effectiveness of different therapeutic strategies after discontinuation, and assessed the rates of response, remission, and adverse effects after infliximab re-initiation. Statistical analyses used time-to-event methods. RESULTS: In the entire cohort, 67 patients (34.7%) relapsed during the follow-up period. The incidence rate of relapse was significantly higher after discontinuation (23.3 per 100 person-years) compared with the control group (7.2 per 100 person-years) in univariable analysis (log-rank P < .001; hazard ratio, 3.41; 95% confidence interval, 1.88-6.20) and multivariable analysis (hazard ratio, 3.70; 95% confidence interval, 2.02-6.77). Rates of hospitalization and colectomy did not differ between groups. Thiopurines appeared to be the best treatment option after infliximab discontinuation (incidence of relapse: 15.0 per 100 person-years for thiopurines, 27.4 per 100 person-years for thiopurines plus aminosalicylates, and 31.2 per 100 person-years for aminosalicylates alone; log-rank P = .032). Response was regained in 77.1% of patients and remission in 51.4% of patients who re-initiated infliximab. However, 17.1% had infusion reactions and 17.1% reported other adverse events. CONCLUSIONS: In a multinational retrospective cohort study of patients with UC in sustained clinical remission, we associated discontinuation of infliximab with an increased risk of relapse. Treatment re-initiation is effective and safe.
BACKGROUND & AIMS:Infliximab is a safe and effective therapy for ulcerative colitis (UC). We conducted a multicenter retrospective cohort study that included 7 European countries and Israel to examine whether infliximab discontinuation can be considered for patients who achieve sustained remission. METHODS: We performed a retrospective cohort study, collecting medical records from 13 tertiary care referral inflammatory bowel disease centers of all patients with UC treated with infliximab (n = 193). We compared the disease course of patients with at least 12 months of clinical remission who discontinued infliximab (n = 111) with that of patients who continued scheduled treatment (controls, n = 82). We examined the incidence rates of relapse, hospitalization and colectomy, the comparative effectiveness of different therapeutic strategies after discontinuation, and assessed the rates of response, remission, and adverse effects after infliximab re-initiation. Statistical analyses used time-to-event methods. RESULTS: In the entire cohort, 67 patients (34.7%) relapsed during the follow-up period. The incidence rate of relapse was significantly higher after discontinuation (23.3 per 100 person-years) compared with the control group (7.2 per 100 person-years) in univariable analysis (log-rank P < .001; hazard ratio, 3.41; 95% confidence interval, 1.88-6.20) and multivariable analysis (hazard ratio, 3.70; 95% confidence interval, 2.02-6.77). Rates of hospitalization and colectomy did not differ between groups. Thiopurines appeared to be the best treatment option after infliximab discontinuation (incidence of relapse: 15.0 per 100 person-years for thiopurines, 27.4 per 100 person-years for thiopurines plus aminosalicylates, and 31.2 per 100 person-years for aminosalicylates alone; log-rank P = .032). Response was regained in 77.1% of patients and remission in 51.4% of patients who re-initiated infliximab. However, 17.1% had infusion reactions and 17.1% reported other adverse events. CONCLUSIONS: In a multinational retrospective cohort study of patients with UC in sustained clinical remission, we associated discontinuation of infliximab with an increased risk of relapse. Treatment re-initiation is effective and safe.