Discontinuation of anti-tumor necrosis factor therapy in inflammatory bowel disease patients: a prospective observation

Abstract

Background: Discontinuation of anti-TNF therapy in patients with inflammatory bowel diseases (IBD) in remission remains a controversial issue. The aims of our study were to assess the proportion of patients who relapse after cessation of biological treatment, and to identify potential risk factors of disease relapse. Methods: Consecutive IBD patients who discontinued anti-TNF therapy in steroid-free clinical and endoscopic remission were prospectively followed. Multiple logistic regression and Cox proportional-hazards models were used to assess the predictors of disease relapse. Results: Seventy-eight IBD patients (Crohn's disease, CD 61; ulcerative colitis, UC 17) were included and followed for a median of 30 months (range 7–47). A total of 32 (53%) CD patients and nine (53%) UC patients relapsed by the end of the follow-up with a median time to relapse of 8 months (range 1–25) in CD patients and 14 months (range 4–37) in UC patients, respectively. The cumulative probabilities of maintaining remission at 6, 12, and 24 months were 82%, 59%, and 51% in CD patients, and 77%, 77%, and 64% in UC patients, respectively. Survival of CD patients who were in deep remission (clinical and endoscopic healing; faecal calprotectin <150 mg/kg; CRP ≤5 mg/l) was not better compared with those who did not fulfill these criteria. In multivariate models, only colonic CD protected patients from disease relapse. Conclusions: Approximately half of the IBD patients relapsed within 2 years after anti-TNF discontinuation. In CD patients, no difference between those who were or were not in deep remission was found. Colonic localization protected patients from relapse.

Keywords:

• Crohn's disease
• ulcerative colitis
• anti-TNF
• treatment discontinuation

Declaration of interest:

This work was supported by the Grant IGA NT14300-3/2013.

Martin Bortlik received consultancy and lecture fees from MSD, Abbvie, and Takeda; Dana Duricova, Nadezda Machkova, Veronika Hruba, Martin Lukas and Katarina Mitrova received lecture fees from MSD; Milan Lukas received consultancy and lecture fees from MSD, Abbvie, and Takeda. Igor Romanko, Vladislav Bina, Karin Malickova and Martin Kolar have nothing to disclose.