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

Remi Mahmoud, Edo H.J. Savelkoul, Dutch Initiative on Crohn's and Colitis (ICC) and the AWARE study group, Wout Mares, Rogier Goetgebuer, Ben J.M. Witteman, Daan B. de Koning, Sebastiaan A.C. van Tuyl, Itta Minderhoud, Maurice W.M.D. Lutgens, Dilek Akol-Simsek, Fiona D.M. van Schaik, Herma H. Fidder, Jeroen M. Jansen, Petra G.A. van Boeckel, Nofel Mahmmod, Carmen S. Horjus-Talabur Horje, Tessa E.H. Römkens, Jean Frédéric Colombel, Frank HoentjenBindia Jharap, Bas Oldenburg*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)
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Abstract

Background & Aims: Discontinuation of anti–tumor necrosis factor-α 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.

Original languageEnglish
Pages (from-to)750-760.e4
JournalClinical Gastroenterology and Hepatology
Volume21
Issue number3
Early online date30 Aug 2022
DOIs
Publication statusPublished - Mar 2023

Bibliographical note

Funding Information:
Funding Support from the Dutch Health Insurance Innovation Fund (unrestricted grant).

Publisher Copyright:
© 2023 The Authors

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