Maintenance of remission Among Patients With Crohn's Disease on Antimetabolite Therapy After Infliximab Therapy Is Stopped

[Tesscorm]

http://www.sciencedirect.com/science/article/pii/S0016508511012935

Maintenance of remission Among Patients With Crohn's Disease on Antimetabolite Therapy After Infliximab Therapy Is Stopped
Edouard Louis⁎, , , Jean–Yves Mary‡, Gwenola Vernier–Massouille§, Jean–Charles Grimaud∥, Yoram Bouhnik¶, David Laharie#, Jean–Louis Dupas⁎⁎, Hélène Pillant‡‡, Laurence Picon§§, Michel Veyrac∥∥, Mathurin Flamant¶¶, Guillaume Savoye##, Raymond Jian⁎⁎⁎, Martine DeVos‡‡‡, Raphaël Porcher‡, Gilles Paintaud§§§, Eric Piver§§, Jean–Frédéric Colombel§, Marc Lemann∥∥∥, Groupe D'etudes Thérapeutiques Des Affections Inflammatoires Digestives
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Background & Aims
It is important to determine whether infliximab therapy can be safely interrupted in patients with Crohn's disease who have undergone a period of prolonged remission. We assessed the risk of relapse after infliximab therapy was discontinued in patients on combined maintenance therapy with antimetabolites and identified factors associated with relapse.

Methods
We performed a prospective study of 115 patients with Crohn's disease who were treated for at least 1 year with scheduled infliximab and an antimetabolite and had been in corticosteroid-free remission for at least 6 months. Infliximab was stopped, and patients were followed up for at least 1 year. We associated demographic, clinical, and biologic factors with time to relapse using a Cox model.

Results
After a median follow-up period of 28 months, 52 of the 115 patients experienced a relapse; the 1-year relapse rate was 43.9% ± 5.0%. Based on multivariable analysis, risk factors for relapse included male sex, the absence of surgical resection, leukocyte counts >6.0 × 109/L, and levels of hemoglobin ≤145 g/L, C-reactive protein ≥5.0 mg/L, and fecal calprotectin ≥300 μg/g. Patients with no more than 2 of these risk factors (approximately 29% of the study population) had a 15% risk of relapse within 1 year. Re-treatment with infliximab was effective and well tolerated in 88% of patients who experienced a relapse.

Conclusions
Approximately 50% of patients with Crohn's disease who were treated for at least 1 year with infliximab and an antimetabolite agent experienced a relapse within 1 year after discontinuation of infliximab. However, patients with a low risk of relapse can be identified using a combination of clinical and biologic markers.

 

[elihogan]

Thanks so much for this post. I hate being on Remicade and mtx, morbid fear of needles. I might have to ask my doctor about this, it's been a bit over a year.

 

[David]

Goodness, I'm not sure how pleased I would be as a patient to partake in this trial. Prolonged remission, stop my treatment, and relapse within a year. And of course, that greatly increases the risk of antibodies being formed.

 

[Lady Organic]

I think most patients go through a phase where they want to stop their medication while on a remission. at that moment, disease is far behind and almost forgotten and something in our psychology wants us to stop taking the treatment... It is known compliance to medication is difficult and especially so when the patients are in remission. Some have success, some have relapse and some have worst relapse than the previous when they decide to cease medication. I think its an experience most of us go through at some point. Ive been there. I took a chance. I regret it because now I am stuck with new chronic extra-intestinal manifestation of disease. But I couldnt know until I tried it. Now with the experiences and flares, I know ''my'' disease needs continuous treatment. But around me, I know of 2 IBD people with more severe history than me who ceased treatment and who have been enjoying ongoing long lasting remissions (up to 7 years) completely meds free.
This study however should definately expand its observations and be a long term one. A one or 2 year fallow up is not enough.

 

[David]

That's a good and fair point.