Objective:To assess the long-term risk of relapse in patients with Crohn's disease (CD) who discontinued infliximab (IFX) monoclonal antibody and to identify risk factors associated with relapse.Methods:A single-center retrospective observational study was conducted from February 2006 to October 2016. The study included CD patients who were treated with scheduled IFX infusions at the First Affiliated Hospital of Sun Yat-sen University and assessed in corticosteroid-free clinical remission at the time of withdrawal were included. The primary outcome was clinical relapse. We evaluated the risk of relapse using Kaplan-Meier method. Factors associated with time to relapse was identified using the multiple Cox proportional hazards regression analysis.Results:We included 97 eligible patients, and 75 (77.3%) experienced a relapse after a median follow-up time of 124 months. Among them, 45 patients (46.4%) relapsed within 3 years after IFX withdrawal. The 1-, 2-, 3-, 5-, and 10-year relapse-free survival were 79.4%, 59.8%, 52.6%, 42.0% and 22.6%, respectively. Risk factors for relapse included age ≤ 16 ( HR = 2.62, 95% CI: 1.30-5.31; P = 0.007) and failure to achieve biological remission (CRP > 3 mg/L, HR = 2.37, 95% CI: 1.29-4.36; P = 0.006) at drug withdrawal. Induction with biologics or systemic steroids were both effective (89%-100% relieved) in relapsers. Conclusions:Nearly half of CD patients relapsed within 3 years after discontinuation of IFX treatment. Early age of discontinuation and failure to achieve serum biological remission at the time of discontinuation are independent predictors of clinical relapse.

Objective:To assess the long-term risk of relapse in patients with Crohn's disease (CD) who discontinued infliximab (IFX) monoclonal antibody and to identify risk factors associated with relapse.Methods:A single-center retrospective observational study was conducted from February 2006 to October 2016. The study included CD patients who were treated with scheduled IFX infusions at the First Affiliated Hospital of Sun Yat-sen University and assessed in corticosteroid-free clinical remission at the time of withdrawal were included. The primary outcome was clinical relapse. We evaluated the risk of relapse using Kaplan-Meier method. Factors associated with time to relapse was identified using the multiple Cox proportional hazards regression analysis.Results:We included 97 eligible patients, and 75 (77.3%) experienced a relapse after a median follow-up time of 124 months. Among them, 45 patients (46.4%) relapsed within 3 years after IFX withdrawal. The 1-, 2-, 3-, 5-, and 10-year relapse-free survival were 79.4%, 59.8%, 52.6%, 42.0% and 22.6%, respectively. Risk factors for relapse included age ≤ 16 ( HR = 2.62, 95% CI: 1.30-5.31; P = 0.007) and failure to achieve biological remission (CRP > 3 mg/L, HR = 2.37, 95% CI: 1.29-4.36; P = 0.006) at drug withdrawal. Induction with biologics or systemic steroids were both effective (89%-100% relieved) in relapsers. Conclusions:Nearly half of CD patients relapsed within 3 years after discontinuation of IFX treatment. Early age of discontinuation and failure to achieve serum biological remission at the time of discontinuation are independent predictors of clinical relapse.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.