Long-term deep remission during maintenance therapy with biological agents in inflammatory bowel diseases

Abstract

Background and aims: A multicentre, retrospective, non-interventional, patient chart review study was conducted to investigate deep (DR) and histological remission rates during maintenance therapy with biological agents in inflammatory bowel disease (IBD).

Methods: We reviewed clinical, endoscopic, and histological findings, and laboratory markers such as C-reactive protein (CRP) and faecal calprotectin (FC) on average of nine years after the initiation of anti-TNF-therapy. DR was defined as no clinical symptoms (The physicians’ global assessment scores; PGA = 0) with endoscopic remission (the Simple Endoscopic Score for Crohn’s Disease [SES-CD] ≤ 2 or Mayo endoscopic subscore ≤1). Histological activity was defined as normal if only architectural alterations without cellularity changes occurred.

Results: Of 117 IBD patients on maintenance therapy, 72 (62%; CD n = 55 [56%], UC n = 17 [85%]) patients were in DR. Of patients in DR, 76% were also in histological remission. 77% of patients remained on initiated biological treatment. UC patients achieved DR significantly more often than CD patients (p = .016). Both median CRP and FC levels were significantly lower in patients with DR.

Conclusion: Reassuringly, almost two thirds of the IBD patients on maintenance therapy with biological agents maintained DR in the long-term, and more than two thirds of patients in DR achieved also histological remission. CD patients in DR had fewer surgical operations due to CD than patients not achieving DR.

Keywords:

• Inflammatory bowel disease
• Crohn’s disease
• ulcerative colitis
• deep remission
• outcome

Author contributions

PM and TS contributed in study design, PM contributed in statistical analysis, PM contributed in initial manuscript drafting. All the authors contributed in critical revision and final approval.

Disclosure statement

Pauliina Molander (PM) has received speaker fees and travel support from Abbvie, Ferring, MSD, Janssen-Cilag, and Tillotts Pharma; has received consulting fees from Abbvie, AOP Orphan Pharmaceuticals, Janssen-Cilag, MSD, Pfizer, Tillotts Pharma, and Takeda. Helena Kemppainen (HK) has received travel support from MSD and Tillotts Pharma; has received consulting fees from Janssen-Cilag. Tuire Ilus (TI) has received speaker fees from Tillotts Pharma. Taina Sipponen (TS) has received speaker fees from Abbvie, Ferring, Janssen-Cilag, MSD, Pfizer, Takeda, and Tillotts Pharma; has received consulting fees from Hospira, Janssen-Cilag, Pfizer, Takeda, and MSD; and has received a research grant from Janssen-Cilag and Takeda.