Is the efficacy of successful infliximab induction therapy maintained for one year lasting without retreatment in different behavior types of Crohn's disease?

Molnár, Tamás; Farkas, Klaudia; Miheller, Pál; Nyári, Tibor; Szepes, Zoltán; Herszényi, László; Műzes, G; Nagy, Ferenc; Tulassay, Z; Wittmann, Tibor

doi:10.1016/j.crohns.2008.07.003

Cited by 20 publications

(9 citation statements)

References 8 publications

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“…First, clinical remission and relapse was based on phycisian's global assessment and not on the clinically validated scoring systems such as the Crohn's Disease Activity Index (CDAI). 7,9,10,13 This may have led to an underestimation of relapse rates observed in this study compared to other studies showing higher relapse rates 7-12 , although the complaints were never severe enough to justify reintroduction of medical or surgical therapy. Second, the study population was heterogeneous as the majority of the patients were treated episodically, which does not reflect the current clinical practice.…”

Section: Discussioncontrasting

confidence: 67%

“…[7][8][9][10][11][12][13][14] Based on this available information, it is now generally recommended not to stop anti-TNF therapy in IBD patients achieving clinical remission. 15,20,21 However, in a real-life clinical setting, it is highly unlikely that IFX can be continued throughout the life span of all IBD patients who have obtained clinical remission.…”

Section: Discussionmentioning

confidence: 99%

“…The only provided evidence comes from STORI, a prospective multi-center study 7 and some small, observational studies. [8][9][10][11][12][13][14] As a result, the decision of discontinuation is typically made on the basis of an individual judgement of benefits versus risks and cost-effectiveness. 15 The main goal of our study was to investigate the long-term outcome of CD patients who discontinued IFX due to clinical remission and to search for predictive factors of prolonged SCR after IFX cessation.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcome of Patients With Crohn’s Disease Who Discontinued Infliximab Therapy Upon Clinical Remission

Papamichael

Casteele

Gils

et al. 2015

Clinical Gastroenterology and Hepatology

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcome of Patients With Crohn’s Disease Who Discontinued Infliximab Therapy Upon Clinical Remission

Papamichael

Casteele

Gils

et al. 2015

Clinical Gastroenterology and Hepatology

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“…43 Domenech et al found significantly increased relapse rates after stopping scheduled biologic therapy in patients with perianal disease compared with those with luminal disease only (82% vs 17%) after a mean follow-up period of 8.8 months. 40 This finding is also supported by a study by Molnar et al 44 Of the remaining studies, 2 were in a pediatric population. 45,46 Both examined the long-term effectiveness of anti-TNF and reported on outcomes after cessation in a small subset of patients.…”

Section: De-escalation Of Anti-tnf In CDsupporting

confidence: 76%

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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“…In most of the studies on withdrawal, patients had the anti-TNF discontinued while they were in clinical remission (with variable definitions of clinical remission and variable duration of remission before drug withdrawal). Relapse rates among those studies range from 21 to 56% at 12 months and from 47 to 64% at 24 month [104,105,106,107,108,109]. Further studies are still required in order to answer the question on whether maintaining the anti-TNF as opposed to reducing/discontinuing the drug is superior to maintain remission; as well as to define routine strategy in the future for long-term management of CD patients and to define the optimal withdrawal strategy [102,103].…”

Section: Withdrawal Of Anti-tnf Therapymentioning

confidence: 99%

Anti-TNF Therapy in Crohn’s Disease

Adegbola

Sahnan

Warusavitarne

et al. 2018

IJMS

217

173

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Crohn’s disease (CD) accounts for a variety of clinical manifestations or phenotypes that stem from chronic inflammation in the gastrointestinal tract. Its worldwide incidence is increasing including younger or childhood-onset of disease. The natural history of Crohn’s disease is characterized by a remitting and relapsing course that progresses to complications and surgery in most patients. The goals of treatment are to achieve clinical and endoscopic remission, to avoid disease progression and minimise surgical resections. Medical treatment usually features antibiotics, corticosteroids, immunomodulators (thiopurines, methotrexate). Anti-TNF (tumour necrosis factor) therapy was approved for use in Crohn’s disease in 1998, and has changed the paradigm of treatment, leading to improved rates of response and remission in patients. There are significant considerations that need to be borne in mind, when treating patients including immunogenicity, safety profile and duration of treatment.

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Is the efficacy of successful infliximab induction therapy maintained for one year lasting without retreatment in different behavior types of Crohn's disease?

Cited by 20 publications

References 8 publications

Long-Term Outcome of Patients With Crohn’s Disease Who Discontinued Infliximab Therapy Upon Clinical Remission

Long-Term Outcome of Patients With Crohn’s Disease Who Discontinued Infliximab Therapy Upon Clinical Remission

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

Anti-TNF Therapy in Crohn’s Disease

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