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Outcome After Discontinuation of TNF-blocking Therapy in Patients with Inflammatory Bowel Disease in Deep Remission

Molander, Pauliina MD*; Färkkilä, Martti MD, PhD†,‡; Salminen, Kimmo MD, PhD§; Kemppainen, Helena MD, PhD§; Blomster, Timo MD; Koskela, Ritva MD, PhD; Jussila, Airi MD; Rautiainen, Henna MD, PhD**; Nissinen, Markku MD, PhD††; Haapamäki, Johanna MD, PhD†,††; Arkkila, Perttu MD, PhD; Nieminen, Urpo MD, PhD; Kuisma, Juha MD, PhD‡‡; Punkkinen, Jari MD, PhD§§; Kolho, Kaija-Leena MD, PhD‖‖; Mustonen, Harri DSc¶¶; Sipponen, Taina MD, PhD

Inflammatory Bowel Diseases:
doi: 10.1097/MIB.0000000000000052
Original Clinical Articles
Abstract

Background: Few data are available on the disease course in patients with inflammatory bowel disease (IBD) in deep remission after discontinuing tumor necrosis factor α (TNFα)–blocking therapy. In this prospective multicenter study, we evaluated the relapse rate, predictive factors, and the response to retreatment after discontinuation of TNFα-blocking therapy in patients with IBD in deep remission.

Methods: We recruited 52 patients (17 Crohn's disease, 30 ulcerative colitis, and 5 IBD unclassified) in clinical, endoscopic, and fecal calprotectin-based (<100 μg/g) remission after at least 1 year of TNFα-blocking therapy. Clinical and endoscopic remission and relapse were defined according to validated indices. After discontinuation of therapy, the patients were followed up with endoscopic assessment at 4 and 12 months. In the event of a clinical relapse with endoscopically active disease or minor clinical symptoms but severe endoscopic relapse, TNFα-blocking therapy was restarted.

Results: After a median follow-up time of 13 (range, 12–15) months, 17/51 (33%) patients relapsed (5/17 Crohn's disease, 12/34 ulcerative colitis/IBD unclassified, 1 patient lost to follow-up at 6 mo). Ten experienced clinical and endoscopic relapse, 5 clinical relapse with mild endoscopic activity, and 2 severe endoscopic relapse. No specific predictive factors were associated with the relapse. Retreatment was effective in 94% of patients.

Conclusions: After cessation of TNFα-blocking therapy in patients with IBD in deep remission, up to 67% remained in clinical remission during the 12-month follow-up. Importantly, 85% of these patients sustained endoscopic remission. The response to restart of TNFα antagonists was effective and well tolerated.

In Brief

Article first published online 2 May 2014.

Author Information

*Department of Medicine, Division of Gastroenterology, Maria Helsinki City Hospital and University of Helsinki, Helsinki, Finland;

Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland;

Division of Gastroenterology, Department of Medicine, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland;

§Department of Medicine, Division of Gastroenterology, Turku University Central Hospital, Turku, Finland;

Department of Medicine, Division of Gastroenterology, Oulu University Central Hospital, Oulu, Finland;

Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland;

**Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland;

††Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Peijas Hospital, Vantaa, Finland;

‡‡Department of Medicine, Hyvinkää Hospital, Hyvinkää, Finland;

§§Department of Medicine, Porvoo Hospital, Porvoo, Finland;

‖‖Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland; and

¶¶Department of Surgery, Helsinki University Central Hospital, Biomedicum Helsinki, Finland.

Reprints: Pauliina Molander, MD, Department of Medicine, Division of Gastroenterology, Maria Helsinki City Hospital, 6501, Helsinki FIN-00099, Finland (e-mail: pauliina.molander@welho.com).

P. Molander received lecture fees from Abbvie and MSD and consulting fees from Abbvie and Tillotts Pharma. M. Färkkilä received consulting fees from MSD, Abbvie, Janssen, Orion Pharma, Medivir, and Roche, and lecture fees from MSD, Abbvie, Bayer, Janssen, and Tillots Pharma. R. Koskela received consulting fees from MSD and lecture fees from Orion Pharma and Tillotts Pharma. T. Blomster received lecture fees from Abbvie and Tillotts Pharma and consulting fees from Abbvie. A. Jussila received lecture fees from Abbvie, MSD, and Tillotts Pharma and consulting fees from Abbvie and MSD. P. Arkkila received lecture fees from Abbvie, MSD, GSK, and Roche. J. Haapamäki received lecture fees from MSD and consulting fees from Tillotts Pharma. H. Rautiainen received lecture fees from MSD, Roche, and Tillotts Pharma. J. M. Punkkinen received consulting fees from Almirall and Shire. K-L. Kolho received consulting fees from MSD, Abbvie, and Tillotts Pharma. The remaining authors have no conflicts of interest to disclose.

Supported by grants from the Helsinki University Central Hospital Research Fund (EVO grant), the Finnish Cultural Foundation, Mary and George C. Ehrnrooth Foundation and Finnish Foundation for Gastroenterological Research.

Received February 19, 2014

Accepted March 24, 2014

© Crohn's & Colitis Foundation of America, Inc.

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