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Complete Endoscopic Healing Is Associated With Lower Relapse Risk After Anti-TNF Withdrawal in Inflammatory Bowel
Remi Mahmoud1, Edo H J Savelkoul2, Wout Mares3
1Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Summary
Stopping anti-tumor necrosis factor-α (anti-TNF) therapy in inflammatory bowel disease (IBD) patients with endoscopic healing leads to high relapse rates. Complete healing and mesalamine use in ulcerative colitis/IBD-unclassified patients reduce relapse risk.
Area of Science:
- Gastroenterology
- Immunology
- Clinical Medicine
Background:
- Discontinuation of anti-tumor necrosis factor-α (anti-TNF) therapy in inflammatory bowel disease (IBD) is linked to significant relapse risks.
- Endoscopic activity at the time of treatment cessation may influence relapse rates.
Purpose of the Study:
- To assess relapse rates following anti-TNF withdrawal in IBD patients who achieved endoscopic healing.
- To identify predictors of relapse, focusing on the depth of endoscopic healing.
Main Methods:
- A multicenter, prospective study involving 81 adult IBD patients (Crohn's disease, ulcerative colitis, IBD-unclassified) in remission.
- Patients discontinued anti-TNF therapy after achieving corticosteroid-free clinical remission and endoscopic healing.
- Kaplan-Meier and Cox regression analyses were used to evaluate relapse rates and predictors, including healing depth and medication use.
Main Results:
- 49% of patients relapsed within a median follow-up of 2.0 years.
- Relapse rates were higher in patients with partial endoscopic healing (70% at 12 months) compared to complete healing (35% at 12 months).
- Mesalamine use was associated with reduced relapse risk in ulcerative colitis/IBD-unclassified patients.
Conclusions:
- High relapse risk exists after anti-TNF withdrawal in IBD patients with endoscopic healing.
- Complete endoscopic healing and mesalamine treatment in specific IBD subtypes significantly decrease relapse risk.
- Reintroduction of anti-TNF therapy led to regained clinical remission in most patients (73%).
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