Long-term Outcomes after the Discontinuation of Anti-TumorNecrosis Factor-α Therapy in Patients with Inflammatory BowelDisease under Clinical Remission: A Korean Association for the Study of Intestinal Disease Multicenter Study
- Author:
Joo Hye SONG
1
;
Eun Ae KANG
;
Soo-Kyung PARK
;
Sung Noh HONG
;
You Sun KIM
;
Ki Bae BANG
;
Kyeong Ok KIM
;
Hong Sub LEE
;
Sang-Bum KANG
;
Seung Yong SHIN
;
Eun Mi SONG
;
Jong Pil IM
;
Chang Hwan CHOI
;
Author Information
- Publication Type:Original Article
- From:Gut and Liver 2021;15(5):752-762
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:Our study aimed to evaluate the long-term outcomes and risk factors forrelapse after anti-tumor necrosis factor (TNF)-α cessation in inflammatory bowel disease (IBD) patients because they are not well established.
Methods:A retrospective multicenter cohort study was conducted involving patients with Crohn’s disease (CD) or ulcerative colitis (UC) from 10 referral hospitals in Korea who discontinued firstline anti-TNF therapy after achieving clinical remission.
Results:A total of 109 IBD patients (71 CD and 38 UC) with a median follow-up duration of 56months were analyzed. The cumulative relapse rates at 1, 3, and 5 years were 11.3%, 46.7%, and 62.5% for CD patients and 28.9%, 45.3%, and 60.9% for UC patients. Multivariable Coxanalysis revealed that discontinuation owing to the clinician’s decision was associated with lower risk of relapse (vs patient’s preference: hazard ratio [HR], 0.13; 95% confidence interval [CI], 0.04 to 0.48; p=0.002) and adalimumab use was associated with higher risk of relapse (vs infliximab: HR, 4.42; 95% CI, 1.24 to 17.74; p=0.022) in CD patients. Mucosal healing was associated with lower risk of relapse (vs nonmucosal healing: HR, 0.12; 95% CI, 0.02 to 0.83; p=0.031) in UC patients. Anti-TNF re-induction was provided to 52 patients, and a response was obtained in 50 patients. However, 25 of them discontinued retreatment owing to a loss of response (n=15), the patient’s preference (n=6), and other factors (n=4).
Conclusions:More than 60% of IBD patients in remission under anti-TNF therapy relapsed within 5 years of treatment cessation. Anti-TNF re-induction was effective. However, half of the patients discontinued anti-TNF therapy, and 50% of these patients discontinued treatment owing to loss of response.
