Evolution After Anti-TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study
Por:
Casanova, MJ, Chaparro, M, Garcia-Sanchez, V, Nantes, O, Leo, E, Rojas-Feria, M, Jauregui-Amezaga, A, Garcia-Lopez, S, Huguet, JM, Arguelles-Arias, F, Aicart, M, Marin-Jimenez, I, Gomez-Garcia, M, Munoz, F, Esteve, M, Bujanda, L, Cortes, X, Tosca, J, Pineda, JR, Manosa, M, Llao, J, Guardiola, J, Perez-Martinez, I, Gonzalez-Lama, Y, Hinojosa, J, Vazquez, JM, Martinez-Montiel, MP, Rodriguez, GE, Pajares, R, Garcia-Sepulcre, MF, Hernandez-Martinez, A, Perez-Calle, JL, Beltran, B, Busquets, D, Ramos, L, Bermejo, F, Barrio, J, Barreiro-de Acosta, M, Roncedo, O, Calvet, X, Hervias, D, Gomollon, F, Dominguez-Antonaya, M, Alcain, G, Sicilia, B, Duenas, C, Gutierrez, A, Lorente-Poyatos, R, Dominguez, M, Khorrami, S, Munoz, C, Taxonera, C, Rodriguez-Perez, A, Ponferrada, A, Van Domselaar, M, Arias-Rivera, ML, Merino, O, Castro, E, Marrero, JM, Martin-Arranz, M, Botella, B, Fernandez-Salazar, L, Monfort, D, Opio, V, Garcia-Herola, A, Menacho, M, Ramirez-de La Piscina, P, Ceballos, D, Almela, P, Navarro-Llavat, M, Robles-Alonso, V, Vega-Lopez, AB, Moraleja, I, Novella, MT, Castano-Milla, C, Sanchez-Torres, A, Benitez, JM, Rodriguez, C, Castro, L, Garrido, E, Domenech, E, Garcia-Planella, E and Gisbert, JP
Publicada:
1 ene 2017
Resumen:
OBJECTIVES: The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed.
METHODS: This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included.
RESULTS: A total of 1,055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn's disease and ulcerative colitis patients, respectively. In both Crohn's disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confi dence interval (CI)= 1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI= 1.07-3.37) or discontinuation because of adverse events (HR= 2.33; 95% CI= 1.27-2.02) vs. a top-down strategy, colonic localization (HR= 1.51; 95% CI= 1.13-2.02) vs. ileal, and stricturing behavior (HR= 1.5; 95% CI= 1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn's disease patients, whereas treatment with immunomodulators after discontinuation (HR= 0.67; 95% CI= 0.51-0.87) and age (HR= 0.98; 95% CI= 0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe.
CONCLUSIONS: The incidence rate of infl ammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identifi ed. Retreatment with the same anti-TNF drug was effective and safe.
Filiaciones:
Casanova, MJ:
Hosp Univ La Princesa, Inst Invest Sanitaria Princesa IIS IP, Dept Gastroenterol, Madrid, Spain
CIBEREHD, Madrid, Spain
Chaparro, M:
Hosp Univ La Princesa, Inst Invest Sanitaria Princesa IIS IP, Dept Gastroenterol, Madrid, Spain
CIBEREHD, Madrid, Spain
Garcia-Sanchez, V:
Hosp Univ Reina Sofia, Cordoba, Spain
Nantes, O:
Complejo Hosp Navarra, Pamplona, Spain
Inst Invest Sanitaria Navarra IdiSNA, Pamplona, Spain
Leo, E:
Hosp Univ Virgen del Rocio, Seville, Spain
Rojas-Feria, M:
Hosp Univ Valme, Seville, Spain
CIBEREHD, Seville, Spain
Jauregui-Amezaga, A:
Hosp Clin Barcelona, Barcelona, Spain
CIBERehd, Barcelona, Spain
Garcia-Lopez, S:
Hosp Univ Miguel Servet, Zaragoza, Spain
Huguet, JM:
Consorcio Hosp Gen Univ Valencia, Valencia, Spain
Arguelles-Arias, F:
Hosp Univ Virgen Macarena, Seville, Spain
Aicart, M:
Hosp Univ Ramon y Cajal, Madrid, Spain
Marin-Jimenez, I:
Hosp Univ Gregorio Maranon, Madrid, Spain
IiSGM, Madrid, Spain
Gomez-Garcia, M:
Hosp Univ Virgen de Las Nieves, Granada, Spain
Munoz, F:
Complejo Univ Leon, Leon, Spain
Esteve, M:
Hosp Univ Mutua Terrassa, Terrassa, Spain
CIBEREHD, Terrassa, Spain
Bujanda, L:
Univ Basque Country, UPV EHU, Inst Biodonostia, Hosp Univ Donostia, Donostia San Sebastian, Spain
CIBEREHD, Donostia San Sebastian, Spain
Cortes, X:
Hosp de Sagunto, Valencia, Spain
Tosca, J:
Hosp Clin Valencia, Valencia, Spain
Pineda, JR:
Complejo Hosp Univ Vigo, Vigo, Spain
:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
CIBEREHD, Badalona, Spain
Llao, J:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Hosp San Juan Dios, Manresa, Spain
Guardiola, J:
Hosp Univ Bellvitge, Barcelona, Spain
Perez-Martinez, I:
Hosp Univ Cent Asturias, Oviedo, Spain
Gonzalez-Lama, Y:
Hosp Univ Puerta de Hierro, Madrid, Spain
Hinojosa, J:
Hosp Manises, Valencia, Spain
Vazquez, JM:
Hosp Juan Ramon Jimenez, Huelva, Spain
Martinez-Montiel, MP:
Hosp Univ Doce Octubre, Madrid, Spain
Rodriguez, GE:
Hosp Univ Nuestra Senora de la Candelaria, Santa Cruz De Tenerife, CA, Spain
Pajares, R:
Hosp Univ Infanta Sofia, Madrid, Spain
Garcia-Sepulcre, MF:
Hosp Gen Univ Elche, Alicante, Spain
Hernandez-Martinez, A:
Hosp Torrecardenas, Almeria, Spain
Perez-Calle, JL:
Hosp Univ Fdn Alcorcon, Madrid, Spain
Beltran, B:
Hosp Univ La Fe, Valencia, Spain
CIBEREHD, Valencia, Spain
Busquets, D:
Hosp Univ Girona Dr Josep Trueta, Girona, Spain
Ramos, L:
Hosp Univ Canarias, San Cristobal la Laguna, Spain
Bermejo, F:
Hosp Univ Fuenlabrada, Madrid, Spain
Barrio, J:
Hosp Univ Rio Hortega, Valladolid, Spain
Barreiro-de Acosta, M:
Hosp Clin Univ Santiago de Compostela, Santiago De Compostela, Spain
Roncedo, O:
Hosp Villafranca de los Caballeros, Toledo, Spain
Calvet, X:
Hosp Sabadell, Corp Sanitaria Univ Parc Tauli, Sabadell, Spain
CIBERehd, Sabadell, Spain
Hervias, D:
Hosp Virgen de Altagracia, Ciudad Real, Spain
Gomollon, F:
Hosp Clin Lozano Blesa, IIS Aragon, Zaragoza, Spain
CIBEREHD, Zaragoza, Spain
Dominguez-Antonaya, M:
Hosp Univ Mostoles, Mostoles, Spain
Alcain, G:
Hosp Virgen de la Victoria, Malaga, Spain
Sicilia, B:
Hosp Univ Burgos, Burgos, Spain
Duenas, C:
Hosp Univ San Pedro Alcantara, Caceres, Spain
Gutierrez, A:
Hosp Gen Univ Alicante, Alicante, Spain
CIBERehd, Alicante, Spain
Lorente-Poyatos, R:
Hosp Gen Ciudad Real, Ciudad Real, Spain
Dominguez, M:
Hosp Gen San Jorge, Huesca, Spain
Khorrami, S:
Hosp Univ Son Espases, Palma De Mallorca, Spain
Munoz, C:
Hosp Basurto, Bilbao, Spain
Hosp Virgen de la Salud, Toledo, Spain
Taxonera, C:
Hosp Univ Clin San Carlos, Madrid, Spain
Inst Invest Hosp Clin San Carlos IdISSC, Madrid, Spain
Rodriguez-Perez, A:
Hosp Univ Salamanca, Salamanca, Spain
Ponferrada, A:
Hosp Univ Infanta Leonor, Madrid, Spain
Van Domselaar, M:
Hosp Torrejon de Ardoz, Madrid, Spain
Arias-Rivera, ML:
Hosp Univ Severo Ochoa, Madrid, Spain
Merino, O:
Hosp Univ Cruces, Baracaldo, Spain
Castro, E:
Hosp Lucus Augusti, Lugo, Spain
Marrero, JM:
Hosp Univ Insular Gran Canaria, Las Palmas Gran Canaria, Spain
Martin-Arranz, M:
Hosp Univ La Paz, Madrid, Spain
Botella, B:
Hosp Univ Infanta Cristina, Madrid, Spain
Fernandez-Salazar, L:
Hosp Clin Univ Valladolid, Valladolid, Spain
Monfort, D:
Consorci Sanitari Terrassa, Terrassa, Spain
Opio, V:
Hosp Univ Getafe, Madrid, Spain
Garcia-Herola, A:
Hosp Marina Baixa, Alicante, Spain
Menacho, M:
Hosp Joan 23, Tarragona, Spain
Ramirez-de La Piscina, P:
Hosp Univ Alava, Vitoria, Spain
Ceballos, D:
Hosp Univ Dr Negrin, Las Palmas Gran Canaria, Spain
Almela, P:
Hosp Gen Univ Castellon, Castellon de La Plana, Spain
Navarro-Llavat, M:
Hosp St Joan Despi Moises Broggi, St Joan Despi, Spain
Robles-Alonso, V:
Hosp Univ Vall dHebron, Barcelona, Spain
Vega-Lopez, AB:
Hosp Viladecans, Barcelona, Spain
Moraleja, I:
Hosp Galdakao Usansolo, Galdakao, Spain
Novella, MT:
Hosp Can Misses, Eivissa, Spain
Castano-Milla, C:
Hosp Univ Rey Juan Carlos, Madrid, Spain
Sanchez-Torres, A:
Hosp Virgen Arrixaca, Murcia, Spain
Benitez, JM:
Hosp Univ Reina Sofia, Cordoba, Spain
Rodriguez, C:
Complejo Hosp Navarra, Pamplona, Spain
Inst Invest Sanitaria Navarra IdiSNA, Pamplona, Spain
Castro, L:
Hosp Univ Virgen Macarena, Seville, Spain
Garrido, E:
Hosp Univ Ramon y Cajal, Madrid, Spain
:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
CIBEREHD, Badalona, Spain
Garcia-Planella, E:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Gisbert, JP:
Hosp Univ La Princesa, Inst Invest Sanitaria Princesa IIS IP, Dept Gastroenterol, Madrid, Spain
CIBEREHD, Madrid, Spain
Green Accepted
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