De-escalating therapy in inflammatory bowel disease: Results from an observational study in clinical practice.

Anti-TNF Colitis ulcerosa Crohn's disease Discontinuación Discontinuation Enfermedad de Crohn Enfermedad inflamatoria intestinal Immunomodulators Inflammatory bowel disease Inmunomoduladores Ulcerative colitis

Journal

Gastroenterologia y hepatologia
ISSN: 0210-5705
Titre abrégé: Gastroenterol Hepatol
Pays: Spain
ID NLM: 8406671

Informations de publication

Date de publication:
08 Aug 2023
Historique:
received: 20 06 2023
revised: 26 07 2023
accepted: 31 07 2023
pubmed: 11 8 2023
medline: 11 8 2023
entrez: 10 8 2023
Statut: aheadofprint

Résumé

Combination therapy with an immunomodulator (IMM) and an anti-TNF is commonly recommended in Crohn's disease (CD) and ulcerative colitis (UC) patients. However, little is known about relapse rates after therapeutic de-escalation. This study aimed to evaluate the risk of relapse in a cohort of UC and CD patients with long-standing clinical remission after discontinuation of IMM or anti-TNF and to identify predictive factors for relapse. This retrospective study included patients with UC or CD on combination therapy and clinical remission for at least 6 months. IMM or anti-TNF was stopped upon physician decision. Primary objective was to evaluate the relapse rates after discontinuation of IMM or anti-TNF and to analyze predictors of relapse. The study included 88 patients, 48 patients (54.5%) discontinued IMM and 40 (45.5%) anti-TNF. During follow-up, relapse rates were 16.7% and 52.5% in the IMM discontinuation group and anti-TNF discontinuation group, respectively (p<0.001). Multivariate analysis showed that anti-TNF discontinuation (HR=3.01; 95% CI=1.22-7.43) and ileal CD location (HR=2.36; 95% CI=1.02-5.47) were predictive factors for relapse while inflammatory CD phenotype was a protective factor (HR=0.32; 95% CI=0.11-0.90). Reintroduction of anti-TNF upon relapse was effective and safe. Anti-TNF discontinuation led to significantly higher relapse rates compared to IMM discontinuation in UC and CD patients on combination therapy. Anti-TNF discontinuation and ileal CD location were identified as predictive factors for relapse while inflammatory CD phenotype was a protective factor. Retreatment after anti-TNF discontinuation was effective and safe.

Sections du résumé

BACKGROUND AND OBJECTIVES OBJECTIVE
Combination therapy with an immunomodulator (IMM) and an anti-TNF is commonly recommended in Crohn's disease (CD) and ulcerative colitis (UC) patients. However, little is known about relapse rates after therapeutic de-escalation. This study aimed to evaluate the risk of relapse in a cohort of UC and CD patients with long-standing clinical remission after discontinuation of IMM or anti-TNF and to identify predictive factors for relapse.
METHODS METHODS
This retrospective study included patients with UC or CD on combination therapy and clinical remission for at least 6 months. IMM or anti-TNF was stopped upon physician decision. Primary objective was to evaluate the relapse rates after discontinuation of IMM or anti-TNF and to analyze predictors of relapse.
RESULTS RESULTS
The study included 88 patients, 48 patients (54.5%) discontinued IMM and 40 (45.5%) anti-TNF. During follow-up, relapse rates were 16.7% and 52.5% in the IMM discontinuation group and anti-TNF discontinuation group, respectively (p<0.001). Multivariate analysis showed that anti-TNF discontinuation (HR=3.01; 95% CI=1.22-7.43) and ileal CD location (HR=2.36; 95% CI=1.02-5.47) were predictive factors for relapse while inflammatory CD phenotype was a protective factor (HR=0.32; 95% CI=0.11-0.90). Reintroduction of anti-TNF upon relapse was effective and safe.
CONCLUSION CONCLUSIONS
Anti-TNF discontinuation led to significantly higher relapse rates compared to IMM discontinuation in UC and CD patients on combination therapy. Anti-TNF discontinuation and ileal CD location were identified as predictive factors for relapse while inflammatory CD phenotype was a protective factor. Retreatment after anti-TNF discontinuation was effective and safe.

Identifiants

DOI: 10.1016/j.gastrohep.2023.07.005 PMID: 37562767
pubmed: 37562767
pii: S0210-5705(23)00376-X
doi: 10.1016/j.gastrohep.2023.07.005
pii:
doi:

Types de publication

Journal Article

Langues

eng spa

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Elsevier España, S.L.U. All rights reserved.

Auteurs

Alex Arenas (A)

Inflammatory Bowel Disease Unit, Hospital Clínic, Barcelona, Spain; Complejo Asistencial Dr. Sótero del Río, Unidad de Gastroenterología, Santiago, Chile; Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Gastroenterología, Santiago, Chile.

María José Moreta (MJ)

Gastroenterology Department, Hospital Clínic, Barcelona, Spain.

Ingrid Ordás (I)

Inflammatory Bowel Disease Unit, Hospital Clínic, Barcelona, Spain; Gastroenterology Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Centro de Investigación Médica en Red (CIBER-EHD), Chile.

Agnès Fernández-Clotet (A)

Inflammatory Bowel Disease Unit, Hospital Clínic, Barcelona, Spain; Gastroenterology Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Centro de Investigación Médica en Red (CIBER-EHD), Chile.

Berta Caballol (B)

Inflammatory Bowel Disease Unit, Hospital Clínic, Barcelona, Spain; Gastroenterology Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Centro de Investigación Médica en Red (CIBER-EHD), Chile.

Marta Gallego (M)

Inflammatory Bowel Disease Unit, Hospital Clínic, Barcelona, Spain; Gastroenterology Department, Hospital Clínic, Barcelona, Spain.

Alejandro Vara (A)

Inflammatory Bowel Disease Unit, Hospital Clínic, Barcelona, Spain; Gastroenterology Department, Hospital Clínic, Barcelona, Spain.

Rebeca Barastegui (R)

Inflammatory Bowel Disease Unit, Hospital Clínic, Barcelona, Spain; Gastroenterology Department, Hospital Clínic, Barcelona, Spain.

Angel Giner (A)

Inflammatory Bowel Disease Unit, Hospital Clínic, Barcelona, Spain; Gastroenterology Department, Hospital Clínic, Barcelona, Spain.

Cristina Prieto (C)

Inflammatory Bowel Disease Unit, Hospital Clínic, Barcelona, Spain; Gastroenterology Department, Hospital Clínic, Barcelona, Spain.

Maria Carme Masamunt (MC)

Inflammatory Bowel Disease Unit, Hospital Clínic, Barcelona, Spain; Gastroenterology Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Centro de Investigación Médica en Red (CIBER-EHD), Chile.

Roberto Candia (R)

Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile.

Elena Ricart (E)

Inflammatory Bowel Disease Unit, Hospital Clínic, Barcelona, Spain; Gastroenterology Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Centro de Investigación Médica en Red (CIBER-EHD), Chile. Electronic address: ericart@clinic.cat.

Classifications MeSH