Complete Endoscopic Healing Is Associated With Lower Relapse Risk After Anti-TNF Withdrawal in Inflammatory Bowel Disease

被引：8

作者：

Mahmoud, Remi ^{[1
]}

Savelkoul, Edo H. J. ^{[2
]}

Mares, Wout ^{[3
]}

Goetgebuer, Rogier ^{[4
,5
]}

Witteman, Ben J. M. ^{[3
]}

de Koning, Daan B. ^{[6
]}

van Tuyl, Sebastiaan A. C. ^{[7
]}

Minderhoud, Itta ^{[8
]}

Lutgens, Maurice W. M. D. ^{[9
]}

Akol-Simsek, Dilek ^{[10
]}

van Schaik, Fiona D. M. ^{[1
]}

Fidder, Herma H. ^{[1
]}

Jansen, Jeroen M. ^{[11
]}

van Boeckel, Petra G. A. ^{[12
]}

Mahmmod, Nofel ^{[12
]}

Horje, Carmen S. Horjus-Talabur ^{[13
]}

Romkens, Tessa E. H. ^{[14
]}

Colombel, Jean-Frederic ^{[15
]}

Hoentjen, Frank ^{[2
,16
]}

Jharap, Bindia ^{[17
]}

Oldenburg, Bas ^{[1
]}

机构：

[1] Univ Med Ctr Utrecht, Dept Gastroenterol & Hepatol, Utrecht, Netherlands

[2] Radboud Univ Nijmegen, Dept Gastroenterol & Hepatol, Med Ctr, Nijmegen, Netherlands

[3] Gelderse Vallei Hosp, Dept Gastroenterol & Hepatol, Ede, Netherlands

[4] Erasmus MC, Dept Gastroenterol & Hepatol, Rotterdam, Netherlands

[5] Univ Amsterdam, Dept Gastroenterol & Hepatol, Med Ctr, Amsterdam, Netherlands

[6] Gelre Hosp, Dept Gastroenterol & Hepatol, Apeldoorn, Netherlands

[7] Diakonessen Hosp, Dept Gastroenterol & Hepatol, Utrecht, Netherlands

[8] Tergooi Med Ctr, Dept Gastroenterol & Hepatol, Hilversum, Netherlands

[9] Elisabeth TweeSteden Hosp, Dept Gastroenterol & Hepatol, Tilburg, Netherlands

[10] DC Klinieken, Dept Gastroenterol & Hepatol, Apeldoorn, Netherlands

[11] OLVG, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands

[12] St Antonius Hosp, Dept Gastroenterol & Hepatol, Nieuwegein, Netherlands

[13] Rijnstate Hosp, Dept Gastroenterol & Hepatol, Arnhem, Netherlands

[14] Jeroen Bosch Hosp, Dept Gastroenterol & Hepatol, Shertogenbosch, Netherlands

[15] Icahn Sch Med Mt Sinai, Div Gastroenterol, Dept Med, New York, NY 10029 USA

[16] Univ Alberta, Dept Med, Div Gastroenterol, Edmonton, AB, Canada

[17] Meander Med Ctr, Dept Gastroenterol & Hepatol, Amersfoort, Netherlands

来源：

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY | 2023年 / 21卷 / 03期

关键词：

De-escalation; Endoscopic Remission; Biologicals; Deep Remission; ULCERATIVE-COLITIS; CROHNS-DISEASE; REMISSION; DISCONTINUATION; INFLIXIMAB; THERAPY; MULTICENTER; PROGRESSION; INDEX;

D O I：

10.1016/j.cgh.2022.08.024

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BACKGROUND & AIMS: Discontinuation of anti-tumor necrosis factor- alpha treatment (anti-TNF) (infliximab and adalimumab) in patients with inflammatory bowel disease (IBD) is associated with a high relapse risk that may be influenced by endoscopic activity at the time of stopping. We assessed the relapse rate after anti-TNF withdrawal in patients with endoscopic healing and studied predictors of relapse including the depth of endoscopic healing. METHODS: This was a multicenter, prospective study in adult patients with Crohn's disease (CD), ulcerative colitis (UC), or IBD-unclassified (IBDU), with >= 6 months of corticosteroid-free clinical remission (confirmed at baseline) and endoscopic healing (Mayo <2/SES-CD <5 without large ulcers), who discontinued anti-TNF between 2018 and 2020 in the Netherlands. We performed Kaplan-Meier and Cox regression analyses to assess the relapse rate and evaluate potential predictors: partial (Mayo 1/SES-CD 3-4) versus complete (Mayo 0/SES-CD 0-2) endoscopic healing, anti-TNF trough levels, and immunomodulator and/or mesalamine use. RESULTS: Among 81 patients (CD: n = 41, 51%) with a median follow-up of 2.0 years (interquartile range, 1.6-2.1), 40 patients (49%) relapsed. Relapse rates in CD and UC/IBDU patients were comparable. At 12 months, 70% versus 35% of patients with partial versus complete endoscopic healing relapsed, respectively (adjusted hazard rate [aHR], 3.28; 95% confidence interval [CI], 1.43-7.50). Mesalamine use was associated with fewer relapses in UC/IBDU patients (aHR, 0.08; 95% CI, 0.01-0.67). Thirty patients restarted anti-TNF, and clinical remission was regained in 73% at 3 months. CONCLUSIONS: The relapse risk was high after anti-TNF withdrawal in IBD patients with endoscopic healing, but remission was regained in most cases after anti-TNF reintroduction. Complete endoscopic healing and mesalamine treatment in UC/IBDU patients decreased the risk of relapse.

引用

页码：750 / +

页数：15

共 50 条

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