Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Mar;21(3):750-760.e4.
doi: 10.1016/j.cgh.2022.08.024. Epub 2022 Aug 31.

Complete Endoscopic Healing Is Associated With Lower Relapse Risk After Anti-TNF Withdrawal in Inflammatory Bowel Disease

Remi Mahmoud  1 , Edo H J Savelkoul  2 , Wout Mares  3 , Rogier Goetgebuer  4 , Ben J M Witteman  3 , Daan B de Koning  5 , Sebastiaan A C van Tuyl  6 , Itta Minderhoud  7 , Maurice W M D Lutgens  8 , Dilek Akol-Simsek  9 , Fiona D M van Schaik  1 , Herma H Fidder  1 , Jeroen M Jansen  10 , Petra G A van Boeckel  11 , Nofel Mahmmod  11 , Carmen S Horjus-Talabur Horje  12 , Tessa E H Römkens  13 , Jean-Frédéric Colombel  14 , Frank Hoentjen  15 , Bindia Jharap  16 , Bas Oldenburg  17 ; Dutch Initiative on Crohn’s and Colitis (ICC) and the AWARE study group
Affiliations
Free article
Multicenter Study

Complete Endoscopic Healing Is Associated With Lower Relapse Risk After Anti-TNF Withdrawal in Inflammatory Bowel Disease

Remi Mahmoud et al. Clin Gastroenterol Hepatol. 2023 Mar.
Free article

Abstract

Background & aims: Discontinuation of anti-tumor necrosis factor-α treatment (anti-TNF) (infliximab and adalimumab) in patients with inflammatory bowel disease (IBD) is associated with a high relapse risk that may be influenced by endoscopic activity at the time of stopping. We assessed the relapse rate after anti-TNF withdrawal in patients with endoscopic healing and studied predictors of relapse including the depth of endoscopic healing.

Methods: This was a multicenter, prospective study in adult patients with Crohn's disease (CD), ulcerative colitis (UC), or IBD-unclassified (IBDU), with ≥6 months of corticosteroid-free clinical remission (confirmed at baseline) and endoscopic healing (Mayo <2/SES-CD <5 without large ulcers), who discontinued anti-TNF between 2018 and 2020 in the Netherlands. We performed Kaplan-Meier and Cox regression analyses to assess the relapse rate and evaluate potential predictors: partial (Mayo 1/SES-CD 3-4) versus complete (Mayo 0/SES-CD 0-2) endoscopic healing, anti-TNF trough levels, and immunomodulator and/or mesalamine use.

Results: Among 81 patients (CD: n = 41, 51%) with a median follow-up of 2.0 years (interquartile range, 1.6-2.1), 40 patients (49%) relapsed. Relapse rates in CD and UC/IBDU patients were comparable. At 12 months, 70% versus 35% of patients with partial versus complete endoscopic healing relapsed, respectively (adjusted hazard rate [aHR], 3.28; 95% confidence interval [CI], 1.43-7.50). Mesalamine use was associated with fewer relapses in UC/IBDU patients (aHR, 0.08; 95% CI, 0.01-0.67). Thirty patients restarted anti-TNF, and clinical remission was regained in 73% at 3 months.

Conclusions: The relapse risk was high after anti-TNF withdrawal in IBD patients with endoscopic healing, but remission was regained in most cases after anti-TNF reintroduction. Complete endoscopic healing and mesalamine treatment in UC/IBDU patients decreased the risk of relapse.

Keywords: Biologicals; De-escalation; Deep Remission; Endoscopic Remission.

PubMed Disclaimer

Publication types