Outcome after discontinuation of infliximab in patients with inflammatory bowel disease in clinical remission: an observational Danish single center study

Abstract

Objective. To investigate duration of remission, including risk factors for relapse and response to retreatment with infliximab (IFX), in patients with Crohn's disease (CD) and ulcerative colitis (UC) who had discontinued IFX while in clinical remission. Methods. Observational, single-center, retrospective study of all patients with a primary response to IFX who discontinued IFX therapy while in steroid-free remission. Relapse was defined as reintroduction of treatment with a biologic, systemic steroid or surgery. Results. Of 219, 53 (24%) CD patients, and 28 of 97 (30%) UC patients discontinued IFX while in clinical steroid-free remission. The proportion of patients in remission declined steadily with 61% of CD patients, and 75% of UC patients being in remission after 1 year. Half the patients maintained remission after median 2 years (680 days (412–948)) and 3.5 years (1334 days (995–1673)), respectively; p = 0.057. Twelve percent with CD and 40% with UC were in remission at the end of follow-up after 10 and 4.5 years, respectively. Longer disease duration was associated with relapse in univariate analysis in CD, OR 1.1 (1.0–1.1), p = 0.022. Of 25, 24 CD patients (96%), and 5 of 7 UC patients (71%) experienced complete clinical remission when retreated with IFX after relapse. Conclusion. While the short-term prognosis seems favorable, the majority of patients who discontinue IFX while in remission relapse over time. The response to retreatment with IFX at relapse seems favorable in this subpopulation.

Key Words::

• clinical outcome
• Crohn's disease
• inflammatory bowel disease
• infliximab
• relapse
• remission
• TNF
• ulcerative colitis

Acknowledgements

Support for this study was provided by unrestricted grants from Aase and Ejnar Danielsen's Foundation, Beckett Foundation, Danish Colitis-Crohn Society, Danish Medical Association Research Foundation, Frode V. Nyegaard and wife's Foundation, Health Science Research Foundation of Region of Copenhagen, Herlev Hospital Research Council, Lundbeck Foundation, and P. Carl Petersens Foundation. The authors would like to thank Tobias Wirenfeldt Klausen, MSc, for statistical assistance (Dept of Haematology, Herlev University Hospital, Denmark), and the nurses at the outpatient clinic at Department of Gastroenterology, Herlev Hospital: Charlotte Kühnel, Yvonne Krogager, Lene Neergaard, and Lise Olsen.

Declaration of interest: Within the last three years, Casper Steenholdt has served as speaker for MSD and Abbott, and as consultant for MSD; Ole Østergaard Thomsen has served as a speaker and consultant for Schering-Plough, UCB, and Zealand Pharma. Jakob Seidelin has served as speaker for MSD and Abbott, and is a consultant for Ferring Pharmaceuticals. Akbar Molazahi, Mark A. Ainsworth, and Jørn Brynskov have no interests to declare.