TY - JOUR
T1 - Discontinuation of Infliximab in Patients With Ulcerative Colitis Is Associated With Increased Risk of Relapse
T2 - A Multinational Retrospective Cohort Study
AU - Fiorino, Gionata
AU - Cortes, Pablo Navarro
AU - Ellul, Pierre
AU - Felice, Carla
AU - Karatzas, Pantelis
AU - Silva, Marco
AU - Lakatos, Peter L.
AU - Bossa, Fabrizio
AU - Ungar, Bella
AU - Sebastian, Shaji
AU - Furfaro, Federica
AU - Karmiris, Konstantinos
AU - Katsanos, Konstantinos H.
AU - Muscat, Martina
AU - Christodoulou, Dimitrios K.
AU - Maconi, Giovanni
AU - Kopylov, Uri
AU - Magro, Fernando
AU - Mantzaris, Gerassimos J.
AU - Armuzzi, Alessandro
AU - Boscà-Watts, Marta Maia
AU - Ben-Horin, Shomron
AU - Bonovas, Stefanos
AU - Danese, Silvio
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Background & Aims Infliximab is a safe and effective therapy for ulcerative colitis (UC). We conducted a multicenter retrospective cohort study that included 7 European countries and Israel to examine whether infliximab discontinuation can be considered for patients who achieve sustained remission. Methods We performed a retrospective cohort study, collecting medical records from 13 tertiary care referral inflammatory bowel disease centers of all patients with UC treated with infliximab (n = 193). We compared the disease course of patients with at least 12 months of clinical remission who discontinued infliximab (n = 111) with that of patients who continued scheduled treatment (controls, n = 82). We examined the incidence rates of relapse, hospitalization and colectomy, the comparative effectiveness of different therapeutic strategies after discontinuation, and assessed the rates of response, remission, and adverse effects after infliximab re-initiation. Statistical analyses used time-to-event methods. Results In the entire cohort, 67 patients (34.7%) relapsed during the follow-up period. The incidence rate of relapse was significantly higher after discontinuation (23.3 per 100 person-years) compared with the control group (7.2 per 100 person-years) in univariable analysis (log-rank P < .001; hazard ratio, 3.41; 95% confidence interval, 1.88–6.20) and multivariable analysis (hazard ratio, 3.70; 95% confidence interval, 2.02–6.77). Rates of hospitalization and colectomy did not differ between groups. Thiopurines appeared to be the best treatment option after infliximab discontinuation (incidence of relapse: 15.0 per 100 person-years for thiopurines, 27.4 per 100 person-years for thiopurines plus aminosalicylates, and 31.2 per 100 person-years for aminosalicylates alone; log-rank P = .032). Response was regained in 77.1% of patients and remission in 51.4% of patients who re-initiated infliximab. However, 17.1% had infusion reactions and 17.1% reported other adverse events. Conclusions In a multinational retrospective cohort study of patients with UC in sustained clinical remission, we associated discontinuation of infliximab with an increased risk of relapse. Treatment re-initiation is effective and safe.
AB - Background & Aims Infliximab is a safe and effective therapy for ulcerative colitis (UC). We conducted a multicenter retrospective cohort study that included 7 European countries and Israel to examine whether infliximab discontinuation can be considered for patients who achieve sustained remission. Methods We performed a retrospective cohort study, collecting medical records from 13 tertiary care referral inflammatory bowel disease centers of all patients with UC treated with infliximab (n = 193). We compared the disease course of patients with at least 12 months of clinical remission who discontinued infliximab (n = 111) with that of patients who continued scheduled treatment (controls, n = 82). We examined the incidence rates of relapse, hospitalization and colectomy, the comparative effectiveness of different therapeutic strategies after discontinuation, and assessed the rates of response, remission, and adverse effects after infliximab re-initiation. Statistical analyses used time-to-event methods. Results In the entire cohort, 67 patients (34.7%) relapsed during the follow-up period. The incidence rate of relapse was significantly higher after discontinuation (23.3 per 100 person-years) compared with the control group (7.2 per 100 person-years) in univariable analysis (log-rank P < .001; hazard ratio, 3.41; 95% confidence interval, 1.88–6.20) and multivariable analysis (hazard ratio, 3.70; 95% confidence interval, 2.02–6.77). Rates of hospitalization and colectomy did not differ between groups. Thiopurines appeared to be the best treatment option after infliximab discontinuation (incidence of relapse: 15.0 per 100 person-years for thiopurines, 27.4 per 100 person-years for thiopurines plus aminosalicylates, and 31.2 per 100 person-years for aminosalicylates alone; log-rank P = .032). Response was regained in 77.1% of patients and remission in 51.4% of patients who re-initiated infliximab. However, 17.1% had infusion reactions and 17.1% reported other adverse events. Conclusions In a multinational retrospective cohort study of patients with UC in sustained clinical remission, we associated discontinuation of infliximab with an increased risk of relapse. Treatment re-initiation is effective and safe.
KW - Anti-TNF Agent
KW - Discontinuation
KW - IBD
KW - Management
KW - Surgery
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U2 - 10.1016/j.cgh.2016.05.044
DO - 10.1016/j.cgh.2016.05.044
M3 - Article
AN - SCOPUS:84991035225
VL - 14
SP - 1426-1432.e1
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
SN - 1542-3565
IS - 10
ER -