P398 Outcome of treatment with biological agents in Crohn's disease: 117 patients in 5 years from a tertiary referral center

Ramos, Lídia Roque; Camba, Alejandro Hernández; Carrillo-Palau, Marta; Alonso, Ignacio González; Alvarez-Buylla, N. Hernandez; Quintero, Enrique

doi:10.1016/s1873-9946(14)60518-3

Cited by 4 publications

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“…A meta‐analysis by our group on the risk of relapse after discontinuation of anti‐TNF therapy in patients with IBD included 27 studies . We found the overall risk of relapse after discontinuation to be 44% for CD (follow‐up range: 6–125 months) and 38% for UC patients (follow‐up range: 6–24 months).…”

Section: What Is the Risk Of Relapse Of Ibd After Discontinuation Of mentioning

confidence: 97%

Systematic review: factors associated with relapse of inflammatory bowel disease after discontinuation of anti‐TNF therapy

Gisbert

Marín

Chaparro

2015

Aliment Pharmacol Ther

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Section: What Is the Risk Of Relapse Of Ibd After Discontinuation Of mentioning

confidence: 97%

Systematic review: factors associated with relapse of inflammatory bowel disease after discontinuation of anti‐TNF therapy

Gisbert

Marín

Chaparro

2015

Aliment Pharmacol Ther

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“…In other studies in which relapse rates were available at 12 and 24 months, 47,[49][50][51][52][53][54][55] the rates ranged from 21.1% to 39% and from 37%% to 55.7%, respectively. Interestingly, except for one study published in abstract form that reported a lower relapse rate of 16% after a mean follow-up of 19 ± 13 months, 56 most studies, including the one by Papamichael et al, reported high cumulative relapse rates of between 49% and 88% by the end of follow-up, 36,37,47,48,52,54,[57][58][59] with higher rates with longer follow-up periods. The median time to relapse was between 4.8 and 16.4 months across the studies reporting this outcome.…”

Section: De-escalation Of Anti-tnf In CDmentioning

confidence: 99%

Systematic Review of Effects of Withdrawal of Immunomodulators or Biologic Agents From Patients With Inflammatory Bowel Disease

et al. 2015

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Little is known about the optimal duration of therapy with an anti-tumor necrosis factor (TNF) agent and/or an immunomodulator for patients with inflammatory bowel disease (IBD). We performed a systematic search of the literature to identify studies reporting after de-escalation (drug cessation or dose reduction) of anti-TNF agents and/or immunomodulators in patients in remission from IBD. Studies were reviewed according to the type of IBD and drug. Rates of relapse, factors associated with relapse, and response to re-treatment were determined. Our search yielded 6315 unique citations; we analyzed findings from 69 studies (18 on de-escalation [drug cessation or dose reduction] of immunomodulator monotherapy, 8 on immunomodulator de-escalation from combination therapy, and 43 on de-escalation of anti-TNF agents, including 3 during pregnancy) comprising 4672 patients. Stopping immunomodulator monotherapy after a period of remission was associated with high rates of relapse in patients with Crohn's disease or ulcerative colitis (approximately 75% of patients experienced a relapse within 5 years after therapy was stopped). Most studies of patients with Crohn's disease who discontinued an immunomodulator after combination therapy found that rates of relapse did not differ from those of patients who continued taking the drug (55%-60% had disease relapse 24 months after they stopped taking the immunomodulator). The only study in patients with ulcerative colitis supported continued immunomodulator use. Approximately 50% of patients who discontinued anti-TNF agents after combination therapy maintained remission 24 months later, but the proportion in remission decreased with time. Markers of disease activity, poor prognostic factors, and complicated or relapsing disease course were associated with future relapse. In conclusion, based on a systematic review, 50% or more of patients with IBD who cease therapy have a disease relapse. Further studies are required to accurately identify subgroups of patients who are good candidates for discontinuation of treatment. The decision to withdraw a drug should be made for each individual based on patient preference, disease markers, consequences of relapse, safety, and cost.Keywords : Crohn's Disease ; Ulcerative Colitis ; Patient Management ; Cessation.Abbreviations used in this paper : anti-TNF, anti-tumor necrosis factor therapy ; CD, Crohn's disease ; CRP, C-reactive protein ; FC, fecal calprotectin ; IBD, inflammatory bowel disease ; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses ; RCT, randomized controlled trial ; TNF, tumor necrosis factor ; UC, ulcerative colitis.Therapeutic strategies in inflammatory bowel disease (IBD) have evolved considerably in the past few decades. The acknowledgment that subclinical and undertreated inflammation can lead to poor outcomes has underpinned a shift in treatment goals from symptomatic control to sustained clinical and endoscopic remission.1 Treatment strategies have changed accordingly, including the ear...

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Cessation of Biologics: Can It Be Done?

Shim

Seow

2017

Treatment of Inflammatory Bowel Disease With Biologics

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P398 Outcome of treatment with biological agents in Crohn's disease: 117 patients in 5 years from a tertiary referral center

Cited by 4 publications

References 0 publications

Systematic review: factors associated with relapse of inflammatory bowel disease after discontinuation of anti‐TNF therapy

Systematic review: factors associated with relapse of inflammatory bowel disease after discontinuation of anti‐TNF therapy

Systematic Review of Effects of Withdrawal of Immunomodulators or Biologic Agents From Patients With Inflammatory Bowel Disease

Cessation of Biologics: Can It Be Done?

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