Maintenance of clinical benefit in Crohn's disease patients after discontinuation of infliximab: long-term follow-up of a single centre cohort
A W G Waugh, S Garg, K Matic, L Gramlich, C Wong, D C Sadowski, M Millan, R Bailey, D Todoruk, R Cherry, C W Teshima, L Dieleman, R N Fedorak, A W G Waugh, S Garg, K Matic, L Gramlich, C Wong, D C Sadowski, M Millan, R Bailey, D Todoruk, R Cherry, C W Teshima, L Dieleman, R N Fedorak
Abstract
Background: Tumour necrosis factor-blockade with infliximab has advanced the treatment of Crohn's disease. While infliximab is efficacious, it remains to be determined whether patients who enter clinical remission with an anti-tumour necrosis factor therapy can have their treatment stopped and retain the state of remission.
Aim: To assess in patients with Crohn's disease who obtained infliximab-induced remission, the proportion who relapsed after infliximab discontinuation.
Methods: This longitudinal cohort study examined patients from a University-based IBD referral centre. Forty eight patients with Crohn's disease in full clinical remission and who then discontinued infliximab were followed up for up to 7 years. Crohn's disease relapse was defined as an intervention with Crohn's disease medication or surgery.
Results: Kaplan-Meier analysis of the proportion of patients with sustained clinical benefit demonstrated that 50% relapsed within 477 days after infliximab discontinuance. In contrast, 35% of patients remained well, and without clinical relapse, up to the end of the nearly 7-year follow-up.
Conclusions: In patients with Crohn's disease with an infliximab-induced remission, stopping infliximab results in a predictable relapse in a majority of patients. Nevertheless, a small percentage of patients sustain a long-term remission.
© 2010 Blackwell Publishing Ltd.
Source: PubMed