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.

Abstract

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.

• 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
• Journal: Gut and liver (Gut Liver) Vol. 15 Issue 5 Pg. 752-762 (09 15 2021) ISSN: 2005-1212 [Electronic] Korea (South)
• PMID: 33767028 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Tumor Necrosis Factor Inhibitors
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab

Topics

• Adalimumab
• Cohort Studies
• Colitis, Ulcerative (drug therapy)
• Humans
• Inflammatory Bowel Diseases (drug therapy)
• Infliximab
• Remission Induction
• Republic of Korea
• Retrospective Studies
• Tumor Necrosis Factor Inhibitors
• Tumor Necrosis Factor-alpha