Consider AZA discontinuation in kids with sustained, deep remission of Crohn’s disease

In children with Crohn’s disease (CD) with sustained clinical and deep remission, cessation of azathioprine (AZA) does not seem to lead to an excess risk of relapse, a recent study has found. In contrast, discontinuation of infliximab (IFX) does entail such a risk.

Researchers enrolled 75 paediatric patients (median age 14.2 years, 64.0 percent male) with moderate-to-severe CD receiving combination therapy with AZA and IFX. Thirty-one (41.3 percent) children met the criteria of sustained clinical remission (CR) of more than 2 years. They also qualified for the definition of deep remission and discontinued either AZA (n=16) or IFX (n=21) according to various criteria; six children discontinued both.

The remaining 44 patients (58.7 percent) achieved CR but not deep remission, and continued combination therapy.

A total of 31 patients experienced clinical relapse, yielding an overall rate of 41.3 percent; meanwhile, 44 children (58.7 percent) maintained CR. Analysis according to subgroups showed that relapse had a prevalence of 25.0 percent in patients who withdrew AZA, 71.4 percent in those who withdrew IFX, and 66.6 percent in those who withdrew both. In those who continued combination treatment, relapse rate was 36.4 percent.

Cox proportional hazards regression analysis confirmed that IFX cessation was a significant risk factor for clinical relapse, raising its likelihood by nearly three times (hazard ratio [HR], 2.982, 95 percent confidence interval [CI], 1.322–6.485; p=0.0081). AZA cessation, on the other hand, had no such effect (HR, 1.078, 95 percent CI, 0.327–3.550; p=0.9021).