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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

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 invo...

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Autores principales: Song, Joo Hye, Kang, Eun Ae, Park, Soo-Kyung, Hong, Sung Noh, Kim, You Sun, Bang, Ki Bae, Kim, Kyeong Ok, Lee, Hong Sub, Kang, Sang-Bum, Shin, Seung Yong, Song, Eun Mi, Im, Jong Pil, Choi, Chang Hwan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Editorial Office of Gut and Liver 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8444111/
https://www.ncbi.nlm.nih.gov/pubmed/33767028
http://dx.doi.org/10.5009/gnl20233
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author Song, Joo Hye
Kang, Eun Ae
Park, Soo-Kyung
Hong, Sung Noh
Kim, You Sun
Bang, Ki Bae
Kim, Kyeong Ok
Lee, Hong Sub
Kang, Sang-Bum
Shin, Seung Yong
Song, Eun Mi
Im, Jong Pil
Choi, Chang Hwan
author_facet Song, Joo Hye
Kang, Eun Ae
Park, Soo-Kyung
Hong, Sung Noh
Kim, You Sun
Bang, Ki Bae
Kim, Kyeong Ok
Lee, Hong Sub
Kang, Sang-Bum
Shin, Seung Yong
Song, Eun Mi
Im, Jong Pil
Choi, Chang Hwan
author_sort Song, Joo Hye
collection PubMed
description 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 first-line 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. (Gut Liver 2021;15-762)
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spelling pubmed-84441112021-09-22 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 Song, Joo Hye Kang, Eun Ae Park, Soo-Kyung Hong, Sung Noh Kim, You Sun Bang, Ki Bae Kim, Kyeong Ok Lee, Hong Sub Kang, Sang-Bum Shin, Seung Yong Song, Eun Mi Im, Jong Pil Choi, Chang Hwan Gut Liver Original Article 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 first-line 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. (Gut Liver 2021;15-762) Editorial Office of Gut and Liver 2021-09-15 2021-03-26 /pmc/articles/PMC8444111/ /pubmed/33767028 http://dx.doi.org/10.5009/gnl20233 Text en Copyright © Gut and Liver. https://creativecommons.org/licenses/by-nc/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Song, Joo Hye
Kang, Eun Ae
Park, Soo-Kyung
Hong, Sung Noh
Kim, You Sun
Bang, Ki Bae
Kim, Kyeong Ok
Lee, Hong Sub
Kang, Sang-Bum
Shin, Seung Yong
Song, Eun Mi
Im, Jong Pil
Choi, Chang Hwan
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8444111/
https://www.ncbi.nlm.nih.gov/pubmed/33767028
http://dx.doi.org/10.5009/gnl20233
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