Long-term outcome of inflammatory bowel disease patients with deep remission after discontinuation of TNFα-blocking agents

Abstract

Background: Little data exist on the long-term prognosis of patients with inflammatory bowel disease (IBD) after stopping TNFα-blocking therapy in deep remission. Existing data indicate that approximately 50% of patients on combination therapy who discontinued TNFα-blockers are still in remission 24 months later. The aims of this follow-up analysis were to evaluate the long-term remission rate after cessation of TNFα-blocking therapy, the predicting factors of a relapse and the response to restarting TNFα blockers.

Methods: The first follow-up data of 51 IBD patients (17 Crohn’s disease [CD], 30 ulcerative colitis [UC] and four inflammatory bowel disease type unclassified [IBDU]) in deep remission at the time of cessation of TNFα-blocking therapy have been published earlier. The long-term data was collected retrospectively after the first follow-up year to evaluate the remission rate and risk factors for the relapse after a median of 36 months.

Results: After the first relapse-free year, 14 out of the remaining 34 IBD patients relapsed (41%; 5/12 [42%] CD and 9/22 [41%] UC/IBDU). Univariate analysis indicated no associations with any predictive factors. Re-treatment was effective in 90% (26/29) of patients.

Conclusion: Of IBD patients in deep remission at the time of cessation of TNFα-blocking therapy, up to 60% experience a clinical or endoscopic relapse after a median follow-up time of 36 months (95% CI 31–41 months). No individual risk factors predicting relapse could be identified. However, the initial response to a restart of TNFα-blockers seems to be effective and well tolerated.

Keywords:

• Crohn’s disease
• ulcerative colitis
• relapse
• stopping
• TNFα-antagonist
• infliximab
• adalimumab

Disclosure statement

PM received lecture fees from Abbvie, Ferring and MSD and consulting fees from Abbvie, MSD, Takeda and Tillotts Pharma. MF received consulting fees from MSD, Abbvie, Janssen, Orion Pharma, Medivir and Roche, and lecture fees from MSD, Abbvie, Bayer, Janssen and Tillots Pharma. TB received lecture fees from Abbvie and Tillotts Pharma and consulting fees from Abbvie. AJ received lecture fees from Abbvie, Ferring, MSD, Takeda and Tillotts Pharma and consulting fees from Abbvie, Hospira, MSD, Takeda and Tillotts Pharma. TS received lecture fees from Abbvie, AstraZeneca, Ferring, Medac, MSD, Pfizer, Tillots Pharma and Vifor Pharma and consulting fees from Hospira, Takeda, MSD and Tillotts Pharma. HK and HM declare no conflicts of interest.