Achievement of deep remission during scheduled maintenance therapy with TNFα-blocking agents in IBD

Molander, Pauliina; Sipponen, Taina; Kemppainen, Helena; Jussila, Airi; Blomster, Timo; Koskela, Ritva; Nissinen, Markku; Rautiainen, Henna; Kuisma, Juha; Kolho, Kaija‐Leena; Färkkilä, Martti

doi:10.1016/j.crohns.2012.10.018

Cited by 98 publications

(75 citation statements)

References 31 publications

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“…Although retreatment with IFX due to relapse is effective and well tolerated, a relevant nonresponse rate of 19% in CD and 46% in ulcerative colitis was reported [23]. Our data demonstrate similar findings with comparable remission rates for CD patients treated with IFX [24]. However, only a minority of CD patients with deep remission in our center, who were started on IFX therapy due to steroid-dependent, steroid-refractory, or complicated disease course, could be successfully discontinued from TNFα inhibitor treatment.…”

Section: Discussionsupporting

confidence: 81%

Low Discontinuation Rate of Infliximab Treatment in Steroid-Dependent/Refractory Crohn’s Disease Patients

et al. 2017

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Background: Many patients with moderate to severe Crohn’s disease (CD) are treated with infliximab (IFX). As most of these patients experience a long-lasting therapy, the outcome and withdrawal of IFX treatment are important clinical questions. Methods: In this retrospective study, we analyzed the treatment outcome in moderate to severe CD patients with a steroid-dependent/refractory disease course started on IFX. Withdrawal of IFX was evaluated in patients with deep remission defined as clinical (Harvey-Bradshaw Index ≤4), biochemical (fecal calprotectin [FC] ≤150 μg/g stool) over a period of 2 years, and endoscopic and histological remission before discontinuation of IFX. Results: After induction with IFX, clinical remission was observed in 45/109 patients (41.3%) and clinical response in 61/109 patients (56.0%). Only 8/109 patients (7.3%) achieved deep remission and therefore could be discontinued from IFX therapy. In 4 of these patients (50%), relapse was observed after discontinuation of IFX treatment. FC decreased in these 8 patients in deep remission from 652 ± 168 μg/g stool (mean ± SE) at baseline to 24.9 ± 8.1 μg/g stool at 14 weeks. When compared to patients in deep remission, FC had decreased significantly less at 14 weeks in patients in clinical remission after induction with IFX (n = 31; 154 ± 55 μg/g stool; p = 0.01), in patients with clinical response after induction achieving clinical remission during the maintenance phase (n = 11; 352 ± 67 μg/g stool; p = 0.004), or in patients with chronic active disease course on maintenance therapy (n = 50; 645 ± 93 μg/g stool; p < 0.001). Conclusion: A low discontinuation rate was observed for steroid-dependent/refractory moderate to severe CD patients with IFX treatment. As FC showed a more or less pronounced decrease depending on the response to the IFX treatment, monitoring of FC may become a noninvasive tool for tailoring biological therapy in CD patients.

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Section: Discussionsupporting

confidence: 81%

Low Discontinuation Rate of Infliximab Treatment in Steroid-Dependent/Refractory Crohn’s Disease Patients

et al. 2017

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“…The final sample included 256 patients (113 women [44.1%] INTRODUCTION Anti-tumor necrosis factor (anti -TNF) antibodies improve the quality of life in patients with inflammatory bowel disease (IBD) 1 and likely modify the course of the disease via mucosal healing and a reduced rate of surgeries. [2][3][4][5][6][7] With an acceptable adverse event profile, TNF inhibitors can be considered the safest and most effective therapy for IBD. 8 The earlier in the course of the disease the anti -TNF treatment is introduced, the higher the probability of response and long -term remission.…”

Section: Results Demographic Characteristics Of Patients Receiving Anmentioning

confidence: 99%

Possible under-treatment of women in Poland with Crohn’s disease: a subgroup analysis from a prospective multicenter study of the use of anti-TNFs

Eder¹,

Kłopocka²,

Wiśniewska-Jarosińska³

et al. 2017

Polish Archives of Internal Medicine

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“…Most clinicians would accept that these patients experience both an excellent control of clinical symptoms coupled with endoscopic remission (mucosal healing, i.e., absence of any endoscopic lesions). [32][33][34][35][36][37] The definition of deep remission is of particular importance in CD, as the correlation between clinical symptoms and endoscopic activity is weak: endoscopic assessment is therefore mandatory. It has to be acknowledged that the EPACT-II Update Panel did not focus on fine-tuning the definition of deep remission as such.…”

Section: Discussionmentioning

confidence: 99%

When do we dare to stop biological or immunomodulatory therapy for Crohn's disease? Results of a multidisciplinary European expert panel

Pittet

Froehlich

Maillard

et al. 2013

Journal of Crohn's and Colitis

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Background: Safety and economic issues have increasingly raised concerns about the long term use of immunomodulators or biologics as maintenance therapies for Crohn's disease (CD). Despite emerging evidence suggesting that stopping therapy might be an option for low risk patients, criteria identifying target groups for this strategy are missing, and there is a lack of recommendations regarding this question. Methods: Multidisciplinary European expert panel (EPACT-II Update) rated the appropriateness of stopping therapy in CD patients in remission. We used the RAND/UCLA Appropriateness Method, and included the following variables: presence of clinical and/or endoscopic remission, CRP level, fecal calprotectin level, prior surgery for CD, and duration of remission (1, 2 or 4 years). Results: Before considering withdrawing therapy, the prerequisites of a C-reactive protein (CRP) and fecal calprotectin measurement were rated as "appropriate" by the panellists, whereas a radiological evaluation was considered as being of "uncertain" appropriateness. Ileo-colonoscopy was considered appropriate 1 year after surgery or after 4 years in the absence of prior surgery. Stopping azathioprine, 6-mercaptopurine or methotrexate mono-therapy was judged appropriate after 4 years of clinical remission. Withdrawing anti-TNF mono-therapy was judged appropriate after 2 years in case of clinical and endoscopic remission, and after 4 years of clinical remission. In case of combined therapy, anti-TNF withdrawal, while continuing the immunomodulator, was considered appropriate after two years of clinical remission. Conclusion: A multidisciplinary European expert panel proposed for the first time treatment stopping rules for patients in clinical and/or endoscopic remission, with normal CRP and fecal calprotectin levels.

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Achievement of deep remission during scheduled maintenance therapy with TNFα-blocking agents in IBD

Abstract: Reassuringly, half of the IBD patients on the TNFα-blocking maintenance therapy achieved deep remission. The majority of patients in deep remission also achieved histological remission.

Cited by 98 publications

References 31 publications

Low Discontinuation Rate of Infliximab Treatment in Steroid-Dependent/Refractory Crohn’s Disease Patients

Low Discontinuation Rate of Infliximab Treatment in Steroid-Dependent/Refractory Crohn’s Disease Patients

Possible under-treatment of women in Poland with Crohn’s disease: a subgroup analysis from a prospective multicenter study of the use of anti-TNFs

When do we dare to stop biological or immunomodulatory therapy for Crohn's disease? Results of a multidisciplinary European expert panel

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