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

Area of Science:

• Gastroenterology
• Immunology
• Pharmacology

Background:

• Anti-tumor necrosis factor (anti-TNF) therapies are crucial for managing inflammatory bowel disease (IBD).
• Discontinuation of anti-TNF therapy in patients achieving remission is common, but relapse rates and associated factors require further investigation.

Purpose of the Study:

• To assess the risk of relapse in IBD patients after discontinuing anti-TNF drugs.
• To identify factors predicting relapse after anti-TNF withdrawal.
• To evaluate the efficacy and safety of retreatment with the same anti-TNF in patients who relapsed.

Main Methods:

• Retrospective, observational, multicenter study.
• Included 1,055 IBD patients who achieved clinical remission and discontinued anti-TNF therapy.
• Analyzed relapse rates, predictive factors for relapse, and outcomes of retreatment.

Main Results:

• Relapse incidence was 19% per patient-year for Crohn's disease and 17% for ulcerative colitis.
• In Crohn's disease, factors like adalimumab vs. infliximab, elective discontinuation, discontinuation due to adverse events, colonic localization, and stricturing behavior increased relapse risk.
• Immunomodulator use post-discontinuation and older age were protective. Retreatment with the same anti-TNF was effective (80% response) and safe. No predictive factors were identified for ulcerative colitis.

Conclusions:

• A significant rate of IBD relapse occurs after anti-TNF discontinuation.
• Specific factors predict relapse risk in Crohn's disease patients.
• Retreatment with the same anti-TNF agent is a safe and effective strategy for managing relapses.