Clinical outcome after anti-tumour necrosis factor therapy discontinuation in 1000 patients with inflammatory bowel disease: the EVODIS long-term study
Por:
Casanova, MJ, Chaparro, M, Nantes, O, Benitez, JM, Rojas-Feria, M, Castro-Poceiro, J, Huguet, JM, Martin-Cardona, A, Aicart-Ramos, M, Tosca, J, Martin-Rodriguez, MD, Gonzalez-Munoza, C, Manosa, M, Leo-Carnerero, E, Lamuela-Calvo, LJ, Perez-Martinez, I, Bujanda, L, Hinojosa, J, Pajares, R, Arguelles-Arias, F, Perez-Calle, JL, Rodriguez-Gonzalez, GE, Guardiola, J, Barreiro-de Acosta, M and Gisbert, JP
Publicada:
1 jun 2021
Ahead of Print:
1 may 2021
Resumen:
Background The long-term outcome of patients after antitumour necrosis factor alpha (anti-TNF) discontinuation is not well known.
Aims To assess the risk of relapse in the long-term after anti-TNF discontinuation.
Methods This was an extension of the evolution after anti-TNF discontinuation in patients with inflammatory bowel disease (EVODIS) study (Crohn's disease or ulcerative colitis patients treated with anti-TNFs in whom these drugs were withdrawn after achieving clinical remission) based in the same cohort of patients whose outcome was updated. Clinical remission was defined as a Harvey-Bradshaw index <= 4 points in Crohn's disease, a partial Mayo score <= 2 in ulcerative colitis and the absence of fistula drainage despite gentle finger compression in perianal disease.
Results This was an observational, retrospective, multicenter study. A total of 1055 patients were included. The median follow-up time was 34 months. The incidence rate of relapse was 12% per patient-year (95% confidence interval [CI] = 11-14). The cumulative incidence of relapse was 50% (95% CI = 47-53): 19% at one year, 31% at 2 years, 38% at 3 years, 44% at 4 years and 48% at 5 years of follow-up. Of the 60% patients retreated with the same anti-TNF after relapse, 73% regained remission. Of the 75 patients who did not respond, 48% achieved remission with other therapies. Of the 190 patients who started other therapies after relapse, 62% achieved remission with the new treatment.
Conclusions A significant proportion of patients who discontinued the anti-TNF remained in remission. In case of relapse, retreatment with the same anti-TNF was usually effective. Approximately half of the patients who did not respond after retreatment achieved remission with other therapies.
Filiaciones:
Casanova, MJ:
Univ Autonoma Madrid UAM, Inst Invest Sanitaria Princesa IIS IP, Hosp Univ La Princesa, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Chaparro, M:
Univ Autonoma Madrid UAM, Inst Invest Sanitaria Princesa IIS IP, Hosp Univ La Princesa, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Nantes, O:
Complejo Hosp Navarra, Inst Invest Sanitaria Navarra IdiSNA, Pamplona, Spain
Benitez, JM:
Hosp Univ Reina Sofia, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Spain
Rojas-Feria, M:
Hosp Univ Valme, Seville, Spain
CIBEREHD, Seville, Spain
Castro-Poceiro, J:
Hosp Clin Barcelona, IDIBAPS, Barcelona, Spain
CIBERehd, Barcelona, Spain
Huguet, JM:
Consorcio Hosp Gen Univ Valencia, Valencia, Spain
Martin-Cardona, A:
Hosp Univ Mutua Terrassa, Terrassa, Spain
CIBEREHD, Terrassa, Spain
Aicart-Ramos, M:
Hosp Univ Ramon y Cajal, Madrid, Spain
Tosca, J:
Hosp Clin Valencia, Valencia, Spain
Univ Valencia, Valencia, Spain
Martin-Rodriguez, MD:
Hosp Univ Virgen Nieves, Granada, Spain
Gonzalez-Munoza, C:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
CIBEREHD, Badalona, Spain
Leo-Carnerero, E:
Hosp Univ Virgen Rocio, Seville, Spain
Lamuela-Calvo, LJ:
Hosp Univ Miguel Servet, Zaragoza, Spain
Inst Invest Sanitaria Aragon IIS Aragon, Zaragoza, Spain
Perez-Martinez, I:
Hosp Univ Cent Asturias, Oviedo, Spain
Bujanda, L:
Univ Pais Vasco UPV EHU, Inst Biodonostia, Hosp Univ Donostia, Donostia San Sebastian, Spain
CIBEREHD, Donostia San Sebastian, Spain
Hinojosa, J:
Hosp Manises, Valencia, Spain
Pajares, R:
Hosp Univ Infanta Sofia, Madrid, Spain
Arguelles-Arias, F:
Hosp Univ Virgen Macarena, Seville, Spain
Perez-Calle, JL:
Hosp Univ Fdn Alcorcon, Madrid, Spain
Rodriguez-Gonzalez, GE:
Hosp Univ Nuestra Senora Candelaria, Santa Cruz de Tenerife, Spain
Guardiola, J:
Hosp Univ Bellvitge, Barcelona, Spain
Barreiro-de Acosta, M:
Hosp Clin Univ Santiago de Compostela, Santiago De Compostela, Spain
Gisbert, JP:
Univ Autonoma Madrid UAM, Inst Invest Sanitaria Princesa IIS IP, Hosp Univ La Princesa, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
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