IBD remission may be maintained even after anti-TNF discontinuation

A large number of patients with inflammatory bowel disease (IBD) remain on remission following discontinuation of antitumour necrosis factor alpha (anti‐TNF) treatment, a study has found. Furthermore, retreatment with the same anti-TNF is usually effective for managing relapse.

The researchers examined the long-term outcome of IBD patients enrolled in the EVODIS (Evolution after anti‐TNF discontinuation) study. A total of 1,055 Crohn's disease or ulcerative colitis patients treated with anti‐TNFs, which were withdrawn after achieving clinical remission, were included in the analysis.

Clinical remission was defined as a Harvey–Bradshaw index ≤4 points in Crohn's disease, a partial Mayo score ≤2 in ulcerative colitis, and the absence of fistula drainage despite gentle finger compression in perianal disease.

Over a median follow‐up of 34 months, relapse occurred at a rate of 12 percent per patient‐year (95 percent confidence interval [CI], 11–14). The incidence of relapse was 19 percent at year 1, 31 percent at year 2, 38 percent at year 3, 44 percent at year 4, and 48 percent at year 5; the cumulative incidence was 50 percent (95 percent CI, 47–53).

Among the patients who relapsed, 60 percent were retreated with the same anti‐TNF. Remission was recaptured in the majority (73 percent) of these patients. Of the 75 patients who did not respond, 48 percent achieved remission with other therapies.

There were 190 patients who started other therapies after relapse, and 62 percent of these achieved remission with the new treatment.