P256. Outcome after discontinuation of infliximab in patients with inflammatory bowel disease in clinical remission
A. Molazahi1, C. Steenholdt1, M. Ainsworth1, J. Brynskov1, O. Thomsen1, J. Seidelin2
1Herlev Hospital, Dept of Gastroenterology, Herlev, Denmark; 2Bispebjerg Hospital, Dept of Internal Medicine, Copenhagen, Denmark
Background: Infliximab (IFX) may induce and maintain remission in Crohn's disease (CD) and ulcerative colitis (UC). To investigate when and in whom IFX therapy can be stopped safely, we aimed to determine duration of remission and risk factors for relapse after discontinuation of IFX in patients in remission. Furthermore, we examined response rate to IFX retreatment.
Methods: Single centre, observational study of all IBD patients with primary response, who discontinued IFX treatment while in steroid free remission. Time to relapse (i.e. need of treatment with a biological, systemic steroid, or surgery) and potential risk factors for relapse (demography, leukocyte count, haemoglobin, C‑reactive protein, and inflammatory activity on endoscopy and CT/MRI-scan, smoking, extend and duration of disease) were recorded. Data were analysed using KaplanMeier statistics, log-rank test, and COX proportional hazard regression analysis.
Results: Fifty-three of 219 (24%) CD patients, and 28 of 97 (30%) UC patients discontinued IFX while in clinical steroid free remission. Sixty-one percent of CD patients and 75% of UC patients were still in remission one year after discontinuing IFX (Figure). Fifty percent of the patients were still in remission after median 680  and 1334  days, respectively, p = 0.057. Univariate analyses indicated an association of longer disease duration with relapse in CD, OR 1.1 [1.01.1], p = 0.022; but this was not confirmed in multivariate analyses. Twenty-four of 25 CD patients (96%), and 5 of 7 UC patients (71%) experienced complete clinical remission at retreatment with IFX after relapse.
Conclusions: Most IBD patients who discontinued IFX while in clinical remission later experienced relapse, with a non-significant trend towards a better prognosis in patients with UC. Retreatment with IFX at relapse in this particular subpopulation was followed by higher remission rates than expected from clinical trials.