Withdrawal of Immunosuppression in Crohn's Disease Treated With Scheduled Infliximab Maintenance: A Randomized Trial

Addressing current treatment challenges in Crohn's disease in real life: A physician's survey

“…The wide range of this interval is in line with the current unequivocal body of evidence from the literature. The six month interval on the lower range is in line with the results from a Belgium withdrawal trial 21 , whereas a longer interval (up to 4 years in our survey) is rather in line with a retrospective analysis 22 , suggesting an increased risk of mono-therapy failure if the thiopurine is withdrawn after <27 month of combo-therapy. Currently, several questions regarding combination therapy remain unanswered, including sustained efficacy and risks beyond one year or adaptability of the conclusions drawn from SONIC to the subcutaneous TNF-antagonists (with the current literature available, the latter may be called into question 43,44 ).…”

“…However, in contrast to this trial the majority of gastroenterologists in our survey stop the immunosuppressive agent first, in line with another European study 21 . Of note, those physicians seeing and treating more IBD patients per year consider a shorter interval being sufficient to initiate withdrawal of medical treatment.…”

“…Aside from treatment optimization de-escalation of therapy after variable duration of clinical remission and associated factors predicting success have been studied [20][21][22] . However, attitude may differ between physicians and between countries.…”

Immunosuppressant combined with infliximab in Crohnʼs Disease: For 6 months, for 2 years, or forever?

“…In the previously published controlled trial comparing immunosuppressant withdrawal after 6 months of combined therapy with infliximab to continued combined therapy, no significant difference in infliximab failure was found between the two groups over a follow-up of 2 years. 2 However, CRP concentrations were significantly higher and infliximab trough levels significantly lower in patients having withdrawn azathioprine. As these features have been associated with an increased risk of treatment failure, a doubt remains about the longterm sustained benefit with infliximab monotherapy.…”

“…In the present study, Oussalah et al found a relapse rate after azathioprine withdrawal very similar to the one found in the IMID study with or without azathioprine withdrawal. 2,3 Interestingly, they could identify predictive factors of relapse: essentially shorter duration of combined therapy and persistent signs of inflammation, i.e., elevated CRP and platelet counts. Biological signs of inflammation have already been associated with the risk of relapse after azathioprine withdrawal in a different clinical setting.…”