Evolution after Anti-TNF Discontinuation in Patients with Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study

Casanova, M. J. ; Chaparro, M. ; García-Sánchez, V. ; Nantes, O. ; Leo, E. ; Rojas-Feria, M. ; Jauregui-Amezaga, A. ; García-López, S. (Universidad de Zaragoza) ; Huguet, J. M. ; Arguelles-Arias, F. ; Aicart, M. ; Marín-Jiménez, I. ; Gómez-García, M. ; Muñoz, F. ; Esteve, M. ; Bujanda, L. ; Cortés, X. ; Tosca, J. ; Pineda, J. R. ; Mañosa, M. ; Llaó, J. ; Guardiola, J. ; Pérez-Martínez, I. ; Muñoz, C. ; González-Lama, Y. ; Hinojosa, J. ; Vázquez, J. M. ; Martinez-Montiel, M. ; Rodríguez, G. E. ; Pajares, R. ; García-Sepulcre, M. F. ; Hernández-Martínez, A. ; Pérez-Calle, J. L. ; Beltrán, B. ; Busquets, D. ; Ramos, L. ; Bermejo, F. ; Barrio, J. ; Barreiro-De Acosta, M. ; Roncedo, O. ; Calvet, X. ; Hervías, D. ; Gomollón, F. (Universidad de Zaragoza) ; Domínguez-Antonaya, M. ; Alcaín, G. ; Sicilia, B. ; Dueñas, C. ; Gutiérrez, A. ; Lorente-Poyatos, R. ; Domínguez, M. ; Khorrami, S. ; Muñoz, C. ; Taxonera, C. ; Rodríguez-Pérez, A. ; Ponferrada, A. ; Van Domselaar, M. ; Arias-Rivera, M. ; Merino, O. ; Castro, E. ; Marrero, J. M. ; Martín-Arranz, M. ; Botella, B. ; Fernández-Salazar, L. ; Monfort, D. ; Opio, V. ; García-Herola, A. ; Menacho, M. ; Ramirez de la Piscina, P. ; Ceballos, D. ; Almela, P. ; Navarro-Llavat, M. ; Robles-Alonso, V. ; Vega-López, A. B. ; Moraleja, I. ; Novella, M. T. ; Castaño-Milla, C. ; Sánchez-Torres, A. ; Benítez, J. M. ; Rodríguez, C. ; Castro, L. ; Garrido, E. ; Domènech, E. ; García-Planella, E. ; Gisbert, J. P.
Evolution after Anti-TNF Discontinuation in Patients with Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study
Resumen: OBJECTIVES:The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed.METHODS:This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included.RESULTS:A total of 1, 055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn''s disease and ulcerative colitis patients, respectively. In both Crohn''s disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confidence interval (CI)=1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI=1.07-3.37) or discontinuation because of adverse events (HR=2.33; 95% CI=1.27-2.02) vs. a top-down strategy, colonic localization (HR=1.51; 95% CI=1.13-2.02) vs. ileal, and stricturing behavior (HR=1.5; 95% CI=1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn''s disease patients, whereas treatment with immunomodulators after discontinuation (HR=0.67; 95% CI=0.51-0.87) and age (HR=0.98; 95% CI=0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe.CONCLUSIONS:The incidence rate of inflammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identified. Retreatment with the same anti-TNF drug was effective and safe.
Idioma: Inglés
DOI: 10.1038/ajg.2016.569
Año: 2017
Publicado en: American Journal of Gastroenterology 112, 1 (2017), 120-131
ISSN: 0002-9270

Factor impacto JCR: 10.231 (2017)
Categ. JCR: GASTROENTEROLOGY & HEPATOLOGY rank: 6 / 80 = 0.075 (2017) - Q1 - T1
Factor impacto SCIMAGO: 4.197 - Hepatology (Q1) - Gastroenterology (Q1)

Tipo y forma: Artículo (PostPrint)
Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)

Derechos Reservados Derechos reservados por el editor de la revista


Exportado de SIDERAL (2019-07-09-13:08:55)


Visitas y descargas

Este artículo se encuentra en las siguientes colecciones:
Artículos



 Registro creado el 2019-06-07, última modificación el 2019-07-09


Postprint:
 PDF
Valore este documento:

Rate this document:
1
2
3
 
(Sin ninguna reseña)