Long-term Outcomes after the Discontinuation of Anti-Tumor Necrosis Factor-α Therapy in Patients with Inflammatory Bowel Disease under Clinical Remission: A Korean Association for the Study of Intestinal Disease Multicenter Study

Bibliographic Details
Title: Long-term Outcomes after the Discontinuation of Anti-Tumor Necrosis Factor-α Therapy in Patients with Inflammatory Bowel Disease under Clinical Remission: A Korean Association for the Study of Intestinal Disease Multicenter Study
Authors: Joo Hye Song, 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, IBD Research Group of the Korean Association for the Study of Intestinal Diseases
Source: Gut and Liver, Vol 15, Iss 5, Pp 752-762 (2021)
Publisher Information: Gastroenterology Council for Gut and Liver, 2021.
Publication Year: 2021
Collection: LCC:Diseases of the digestive system. Gastroenterology
Subject Terms: inflammatory bowel diseases, tumor necrosis factor inhibitors, withholding treatment, recurrence, Diseases of the digestive system. Gastroenterology, RC799-869
More Details: Background/Aims: Our study aimed to evaluate the long-term outcomes and risk factors for relapse 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 56 months 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 Cox analysis 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.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 1976-2283
Relation: http://gutnliver.org/journal/view.html?doi=10.5009/gnl20233; https://doaj.org/toc/1976-2283
DOI: 10.5009/gnl20233
Access URL: https://doaj.org/article/10278569203c4e988ebbdbb145f2d142
Accession Number: edsdoj.10278569203c4e988ebbdbb145f2d142
Database: Directory of Open Access Journals
More Details
ISSN:19762283
DOI:10.5009/gnl20233
Published in:Gut and Liver
Language:English