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Evolution After Anti-TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study

Publicado en:American Journal Of Gastroenterology. 112 (1): 120-131 - 2017-01-01 112(1), DOI: 10.1038/ajg.2016.569

Autores: Casanova, M J; Chaparro, M; Garcia-Sanchez, V; Nantes, O; Leo, E; Rojas-Feria, M; Jauregui-Amezaga, A; Garcia-Lopez, S; Huguet, J M; Arguelles-Arias, F; Aicart, M; Marin-Jimenez, I; Gomez-Garcia, M; Munoz, F; Esteve, M; Bujanda, L; Cortes, X; Tosca, J; Pineda, J R; Manosa, M; Llao, J; Guardiola, J; Perez-Martinez, I; Munoz, C; Gonzalez-Lama, Y; Hinojosa, J; Vazquez, J M; Martinez-Montiel, M P; Rodriguez, G E; Pajares, R; Garcia-Sepulcre, M F; Hernandez-Martinez, A; Perez-Calle, J L; Beltran, B; Busquets, D; Ramos, L; Bermejo, F; Barrio, J; Barreiro-de Acosta, M; Roncedo, O; Calvet, X; Hervias, D; Gomollon, F; Dominguez-Antonaya, M; Alcain, G; Sicilia, B; Duenas, C; Gutierrez, A; Lorente-Poyatos, R; Dominguez, M; Khorrami, S; Taxonera, C; Rodriguez-Perez, A; Ponferrada, A; Van Domselaar, M; Arias-Rivera, M L; Merino, O; Castro, E; Marrero, J M; Martin-Arranz, M; Botella, B; Fernandez-Salazar, L; Monfort, D; Opio, V; Garcia-Herola, A; Menacho, M; Ramirez-de la Piscina, P; Ceballos, D; Almela, P; Navarro-Llavat, M; Robles-Alonso, V; Vega-Lopez, A B; Moraleja, I; Novella, M T; Castano-Milla, C; Sanchez-Torres, A; Benitez, J M; Rodriguez, C; Castro, L; Garrido, E; Domenech, E; Garcia-Planella, E; Gisbert, J P

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OBJECTIVES: The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed.METHODS: This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included.RESULTS: A total of 1,055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn's disease and ulcerative colitis patients, respectively. In both Crohn's disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confi dence interval (CI)= 1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI= 1.07-3.37) or discontinuation because of adverse events (HR= 2.33; 95% CI= 1.27-2.02) vs. a top-down strategy, colonic localization (HR= 1.51; 95% CI= 1.13-2.02) vs. ileal, and stricturing behavior (HR= 1.5; 95% CI= 1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn's disease patients, whereas treatment with immunomodulators after discontinuation (HR= 0.67; 95% CI= 0.51-0.87) and age (HR= 0.98; 95% CI= 0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe.CONCLUSIONS: The incidence rate of infl ammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identifi ed. Retreatment with the same anti-TNF drug was effective and safe.

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