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Evolution After Anti-TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study

2016; Lippincott Williams & Wilkins; Volume: 112; Issue: 1 Linguagem: Inglês

10.1038/ajg.2016.569

1572-0241

María José Casanova, María Chaparro, Valle García–Sánchez, Óscar Nantes, E Leo, M Rojas-Feria, Aranzazu Jauregui-Amezaga, Santiago García‐López, José María Huguet, Federico Argüelles‐Arias, Marta Aicart, Ignacio Marín‐Jiménez, María Gómez–García, Fernándo Muñoz, María Esteve, Luís Bujanda, Xavier Cortés, Joan Toscá, J R Pineda, Míriam Mañosa, J Llaó, Jordi Guardiola, Isabel Pérez‐Martínez, Clara Muñoz, Yago González‐Lama, Joaquín Hinojosa, J.M. Vázquez, Pilar Martínez-Montiel, G E Rodríguez, Ramón Pajares, Mariana Fe García-Sepulcre, Álvaro Hernández-Martínez, J L Pérez-Calle, Belén Beltrán, David Busquets, Laura Ramos, Fernando Bermejo, Jesús Barrio, Manuel Barreiro‐de Acosta, O Roncedo, Xavier Calvet, Daniel Hervías, Fernando Gomollón, Mercedes Domínguez-Antonaya, G Alcaín, Beatriz Sicilia, Carmelo Dueñas Castell, Ana Gutiérrez, Rufo Humberto Lorente-Poyatos, M.Á. Domínguez, Sam Khorrami, Carlos Taxonera, Aurelio Rodríguez, Ángel Ponferrada, Manuel Van Domselaar, María Luisa Arias-Rivera, Olga Merino, Esmeralda Gracián-Castro, José Miguel Marrero, María Dolores Martín‐Arranz, Belén Botella, Luís Fernández-Salazar, David Monfort, Verónica Opio, Antonio García‐Herola, M Menacho, Ramírez-de P la Piscina, Daniel Ceballos, Pedro Almela, Mercè Navarro-Llavat, Virginia Robles, ANAHI VEGA-LOPEZ, Irene Moraleja, M T Novella, Carlos Castańo-Milla, Alba Sánchez‐Torres, J M Benítez, Cristina Rodríguez, Luisa de Castro, Elena Azaola, Eugeni Domènech, E. García‐Planella, Javier P. Gisbert,

Immunodeficiency and Autoimmune Disorders

The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed.This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included.A total of 1,055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn's disease and ulcerative colitis patients, respectively. In both Crohn's disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confidence interval (CI)=1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI=1.07-3.37) or discontinuation because of adverse events (HR=2.33; 95% CI=1.27-2.02) vs. a top-down strategy, colonic localization (HR=1.51; 95% CI=1.13-2.02) vs. ileal, and stricturing behavior (HR=1.5; 95% CI=1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn's disease patients, whereas treatment with immunomodulators after discontinuation (HR=0.67; 95% CI=0.51-0.87) and age (HR=0.98; 95% CI=0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe.The incidence rate of inflammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identified. Retreatment with the same anti-TNF drug was effective and safe.