Relapse rates of inflammatory bowel disease patients in deep and clinical remission after discontinuing anti-tumor necrosis factor alpha therapy

BACKGROUND AND AIMS: Relapse rates after discontinuing anti-tumor necrosis factor-alpha (TNF alpha) therapy of inflammatory bowel disease (IBD) patients in deep remission are poorly understood. This prospective single center open-label study evaluated the relapse rates of IBD patients after stopping anti-TNF alpha therapy. METHODS: All IBD patients who were in clinical remission and stopped anti-TNF alpha therapy in 2011-2013 and were followed up for at least 12 months were enrolled. The "Ultradeep" patients were in calprotectin-negative (<50 ng/g) deep remission for at least six months and ceased anti-TNF alpha therapy on physician recommendations. The "clinical" patients were in clinical but not deep remission and ceased anti-TNF alpha therapy for other reasons. Relapse rates were assessed and relapse risk factors identified. RESULTS: One year after stopping, 27 % and 27 % of the Ultradeep (n = 11) and Clinical (n = 11) patients relapsed, respectively. Two years after stopping, 57 % and 62 % relapsed, respectively (p = 0.89). All relapsed patients who underwent retreatment with anti-TNF alpha therapy re-entered remission. Male sex was a significant risk factor for relapse (p = 0.03). CONCLUSION: Our study showed that even highly selected IBD patients who lack clinical, endoscopic or laboratory signs of disease activity have a relatively high relapse rate in the follow-up period after ceasing anti-TNF alpha therapy (Tab. 2, Fig. 3, Ref. 24). Text in PDF www.elis.sk.