Long-term clinical outcome after infliximab discontinuation in patients with inflammatory bowel disease

Lee, Ji Min; Kim, Yoon Jae; Lee, Kang Moon; Yoon, Hyuk; Lee, Bo In; Kim, Dae Bum; Kang, Donghoon

doi:10.1080/00365521.2018.1524024

Cited by 11 publications

(13 citation statements)

References 22 publications

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“…Only few studies have evaluated the longterm clinical outcome after anti-TNF withdrawal. [5][6][7][14][15][16] Moreover, the present study is one of the few that assessed disease outcome in patients who did not respond to retreatment with the same anti-TNF or in patients treated with other therapeutic strategies after relapse.…”

Section: Discussionmentioning

confidence: 99%

“…Long-term data after anti-TNF discontinuation are scant, and the few studies that reported long-term relapse rates after withdrawal included limited number of patients. [5][6][7] Thus, the real long-term clinical outcome of patients after anti-TNF discontinuation is not well known.…”

Section: Introductionmentioning

confidence: 99%

“…However, most of the studies analysed in this meta‐analysis included a small number of patients and had a short follow‐up time. Long‐term data after anti‐TNF discontinuation are scant, and the few studies that reported long‐term relapse rates after withdrawal included limited number of patients 5‐7 . Thus, the real long‐term clinical outcome of patients after anti‐TNF discontinuation is not well known.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcome after anti‐tumour necrosis factor therapy discontinuation in 1000 patients with inflammatory bowel disease: the EVODIS long‐term study

Casanova¹,

Chaparro²,

Nantes³

et al. 2021

Aliment Pharmacol Ther

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Summary Background The long‐term outcome of patients after antitumour necrosis factor alpha (anti‐TNF) discontinuation is not well known. Aims To assess the risk of relapse in the long‐term after anti‐TNF discontinuation. Methods This was an extension of the evolution after anti‐TNF discontinuation in patients with inflammatory bowel disease (EVODIS) study (Crohn's disease or ulcerative colitis patients treated with anti‐TNFs in whom these drugs were withdrawn after achieving clinical remission) based in the same cohort of patients whose outcome was updated. Clinical remission was defined as a Harvey–Bradshaw index ≤4 points in Crohn's disease, a partial Mayo score ≤2 in ulcerative colitis and the absence of fistula drainage despite gentle finger compression in perianal disease. Results This was an observational, retrospective, multicenter study. A total of 1055 patients were included. The median follow‐up time was 34 months. The incidence rate of relapse was 12% per patient‐year (95% confidence interval [CI] = 11‐14). The cumulative incidence of relapse was 50% (95% CI = 47‐53): 19% at one year, 31% at 2 years, 38% at 3 years, 44% at 4 years and 48% at 5 years of follow‐up. Of the 60% patients retreated with the same anti‐TNF after relapse, 73% regained remission. Of the 75 patients who did not respond, 48% achieved remission with other therapies. Of the 190 patients who started other therapies after relapse, 62% achieved remission with the new treatment. Conclusions A significant proportion of patients who discontinued the anti‐TNF remained in remission. In case of relapse, retreatment with the same anti‐TNF was usually effective. Approximately half of the patients who did not respond after retreatment achieved remission with other therapies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical outcome after anti‐tumour necrosis factor therapy discontinuation in 1000 patients with inflammatory bowel disease: the EVODIS long‐term study

Casanova¹,

Chaparro²,

Nantes³

et al. 2021

Aliment Pharmacol Ther

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“… 16 This ranges from 30% to as high as 60% in some studies, depending on follow-up periods. 18 – 20 …”

Section: Introductionmentioning

confidence: 99%

“…16 This ranges from 30% to as high as 60% in some studies, depending on follow-up periods. [18][19][20] Based on current evidence, patients who have 'deep' remission confirmed objectively prior to biologic withdrawal are more likely to remain in remission at 12 months of follow-up, and this is more often seen in Ulcerative Colitis (UC) than Crohn's Disease (CD). 21 To help aid the decision of withdrawal, some studies have attempted to identify risk factors for relapse after discontinuation of therapy 18 but at present there are no controlled studies to confirm the best strategy and benefits of withdrawal.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes, predictors of prognosis and health economics consequences in IBD patients after discontinuation of the first biological therapy

Shivaji

Bazarova²,

Critchlow

et al. 2020

Therap Adv Gastroenterol

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Background: In real-world clinical practice, biologics in inflammatory bowel diseases (IBD) may be discontinued for a variety of reasons, including discontinuation initiated by gastroenterologists. The aims of the study are to report outcomes after discontinuation and predictors of prognosis after a minimum follow-up of 24 months; outcomes of gastroenterologist-initiated discontinuation with resulting direct cost implications on the health system were also studied. Methods: IBD patients who discontinued their first-use biologics between January 2013 and December 2016 were identified at our tertiary centre. Reasons for discontinuation and pre-defined adverse outcomes (AO) were recorded. Data were analysed using univariable and multivariable logistic regressions within a machine learning technique to predict AO. Gastroenterologist-initiated discontinuations were analysed separately, and Kaplan–Meier survival analysis performed; direct costs of AO due to discontinuation were assessed. Results: A total of 147 patients discontinued biologics (M = 74; median age 39 years; Crohn’s Disease = 110) with median follow-up of 40 months (range 24–60 months). In the total cohort, there were fewer AO among gastroenterologist-initiated discontinuations compared with patient-initiated; 54% (of the total group) had AO within 6 months. Among 59 gastroenterologist-initiated discontinuations, 23 (40%) had IBD-related AO within 6 months and 53 (90%) patients had AO by end of follow-up. Some 44 (75%) patients needed to restart biologics during follow-up, and direct costs due to AO and restart of biologics were high. Conclusions: The proportion of patients who have AO following discontinuation of biologics is high; clinicians need to carefully consider predictors of poor prognosis and high relapse rates when discussing discontinuation. The direct costs of managing AO probably offset theoretical economic gains, especially in the era where cost of biologics is reducing. Biologics should probably be continued without interruptions in most patients who have achieved remission for the duration these remain effective and safe.

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Suboptimal Outcomes and Retreatment Rate of Patients With Crohn's Disease After Forced Discontinuation of Biologics: A Nationwide Population‐Based Study

Chen

Chuang

Chang

et al. 2023

Clin Pharma and Therapeutics

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Taiwan's National Health Insurance programme forced discontinuation of biologic use in Crohn's disease after a limited treatment duration, regardless of disease activity. This study investigated the retreatment rate and suboptimal outcomes [i.e., Crohn's disease–related surgeries, hospitalisations, emergency room visits and oral steroid flare‐ups] after forced discontinuation. This retrospective cohort study was conducted using data from the National Health Insurance Database. Patients who received ≥40 weeks of biologic treatment followed by a forced discontinuation were included. The time of biologic retreatment and the cumulative incidence of suboptimal outcomes after the forced discontinuation as well as related risk factors were analyzed. 215 patients were included [68% male]. At the beginning of biologic therapy, the mean age [±SD] was 35.7 [±13.5] years, and the disease duration was 4.46 [±3.52] years. The median [interquartile range] biologic treatment duration was 57.86 [50.3–83.3] weeks. Within the first year after forced discontinuation, 67% of patients [n = 144] were retreated with a second course of biologics, and 53% of patients [n = 114] experienced at least one suboptimal outcome. The independent risk factors associated with the occurrence of suboptimal outcomes were Crohn's disease–related emergency room visits and hospitalisations during biologic therapy [hazard ratio: 2.49; 95% CI: 1.59–3.89]. More than two‐thirds of CD patients required biological retreatment within 1 year after a forced discontinuation. The substantial proportion of patients with poor disease outcomes highlights the need to continue the biologic.

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Long-term clinical outcome after infliximab discontinuation in patients with inflammatory bowel disease

Cited by 11 publications

References 22 publications

Clinical outcome after anti‐tumour necrosis factor therapy discontinuation in 1000 patients with inflammatory bowel disease: the EVODIS long‐term study

Clinical outcome after anti‐tumour necrosis factor therapy discontinuation in 1000 patients with inflammatory bowel disease: the EVODIS long‐term study

Clinical outcomes, predictors of prognosis and health economics consequences in IBD patients after discontinuation of the first biological therapy

Suboptimal Outcomes and Retreatment Rate of Patients With Crohn's Disease After Forced Discontinuation of Biologics: A Nationwide Population‐Based Study

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