Sa1270 Can We Increase the Dose Interval of Infliximab to 10 Weeks Without Risking Loss of Response in Patients With Crohn's Disease? Prospective, Single-Center Pilot Study Based on Successive Measurements of Fecal Calprotectin

Mantzaris, Gerassimos J.; Kyriakos, Nikolaos; Archavlis, Emmanuel; Papamichael, Konstantinos; Tzannetakou, Xanthippi; Internos, I.; Anastasiadis, S.; Tsironikos, Dimitrios; Drougas, Ioannis

doi:10.1016/s0016-5085(14)60874-x

Cited by 7 publications

(8 citation statements)

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“…Twenty-two were retrospective cohort studies, and 15 were prospective cohort studies. One study 34 comparing two different maintenance anti-TNF regimens (8 weekly vs 10 weekly dosing) had a control arm, but all others did not. No RCTs were found.…”

Section: De-escalation Of Anti-tnfmentioning

confidence: 99%

“…In only one study, in a group of patients with surgically induced remission, was anti-TNF de-escalated after use as monotherapy. 35 In 6 studies, the proportion of patients on a concomitant immunomodulator was not specified 34,[36][37][38][39] ; in the remaining studies, it ranged from 20 to 100%. Three studies [40][41][42] compared relapse rates after infliximab withdrawal after induction alone ("induction group") with relapse rates after withdrawal after at least 1 year of scheduled maintenance therapy ("maintenance group").…”

Section: De-escalation Of Anti-tnf In CDmentioning

confidence: 99%

“…The relapse rate at 6 months after withdrawal was 83.3%; in all cases, patients were re-treated successfully with a lower dose of infliximab (3 mg/kg). Mantzaris et al 34 reported relapse rates in patients with CD in deep long-term remission who had their infliximab spaced from 8 to 10 weeks; the relapse rate was 6.25% at 12 months for the drug spacing group and 6.7% for the drug continuation group.…”

Section: De-escalation Of Anti-tnf In CDmentioning

confidence: 99%

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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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Section: De-escalation Of Anti-tnfmentioning

confidence: 99%

Section: De-escalation Of Anti-tnf In CDmentioning

confidence: 99%

Section: De-escalation Of Anti-tnf In CDmentioning

confidence: 99%

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

et al. 2015

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“…Many studies have now looked into anti-TNF withdrawal in Crohn's disease (see Table 1 for a summary of most relevant studies). 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 The STORI trial (Infliximab diSconTinuation in Crohn's disease patients in stable Remission on combined therapy with Immunosuppressors) was the pivotal study boosting clinical research in this topic, being thereafter followed by many studies. This was a multicenter study led by the GETAID, and it was the first prospective study specifically designed to assess the risk of relapse, and to identify predictors of relapse following anti-TNF maintenance therapy withdrawal.…”

Section: What Are the Relapse Rates After Stopping?mentioning

confidence: 99%

“…Note : only factors identified through multivariable analysis across different studies are presented in this table. Factors predictive of relapse Reflective of disease activity at de-escalation or during follow-up • Elevated inflammatory markers (elevated leukocyte count, 34 , 41 elevated CRP, 24 , 31 , 34 escalation, 51 , 52 elevated FC 25 , 34 , 41 • Laboratorial markers suggestive of ongoing inflammation (low hemoglobin) 34 • Absence of mucosal healing 24 , 34 Factors reflective of disease poor prognostic features • Smoking 29 , 31 • Perianal disease 29 • Disease location (ileocolonic disease 35 ; colonic versus ileal or ileocolonic disease 46 ) • Young age at diagnosis 41 , 42 Previous disease course • Prior disease course marked by higher therapeutic requirements (higher steroid use, 34 prior anti-TNF course * , 31 , 35 , 49 need for dose-escalation prior to discontinuation, 31 prior immunomodulator failure 29 ) Other • Male sex (HR 3.7 [1.9–7.4]) 34 • Elevated/detectable IFX trough levels 34 ...…”

Section: Can We Predict Relapse After Anti-tnf Discontinuation?mentioning

confidence: 99%

Anti-TNF Withdrawal in Inflammatory Bowel Disease

Torres

Cravo

Colombel

2016

GE Portuguese Journal of Gastroenterology

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The introduction of the anti-tumor necrosis factorα agents (anti-TNFα) in clinical practice has greatly advanced the treatment of inflammatory bowel disease. The use of these medications results in durable remission in a subset of patients, preventing surgery and hospitalizations. However, there are some concerns about safety and costs associated with their long-term use. Therefore, anti-TNF withdrawal has emerged as an important consideration in clinical practice. Herein our goal was to discuss the available evidence about anti-TNFα discontinuation in IBD that could inform the clinician on the expected rates of relapse, the potential predictors of relapse, as well the response to re-treatment.

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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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Sa1270 Can We Increase the Dose Interval of Infliximab to 10 Weeks Without Risking Loss of Response in Patients With Crohn's Disease? Prospective, Single-Center Pilot Study Based on Successive Measurements of Fecal Calprotectin

Cited by 7 publications

References 0 publications

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

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

Anti-TNF Withdrawal in Inflammatory Bowel Disease

Cessation of Biologics: Can It Be Done?

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