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P403. Predictors of relapse after discontinuing anti-TNF therapy in Crohn's disease patients on deep remission

A. Echarri1, V. Ollero1, J.A. Rodriguez1, J.C. Gallego2, J. Castro1, 1Complejo Hospitalario Universitario de Ferrol, Gastroenterology, Spain, 2Complejo Hospitalario Universitario de Ferrol, Radiology, Spain

Background

Anti-TNF therapy has proven effective in maintaining remission of Crohn's disease (CD). The stopping of anti-TNF treatment may be considered for various reasons, including cost and concerns about safety. Endoscopically active disease or high CRP at time of treatment discontinuation is associated with early recurrence, thus we should only plan the discontinuance of anti-TNF drugs in patients with clinical remission and mucosal healing.

Objectives: To assess the proportion of CD patients in anti-TNF induced deep remission that relapsed after infliximab or adalimumab discontinuation.

Methods

A total of 32 CD patients in deep remission were monitored after discontinuation of their anti-TNF treatment. Deep remission can be defined as steroid-free clinical remission, mucosal healing assessed by endoscopy and the absence of activity as confirmed by bowel MRI (in cases of ileal involvement). Follow-up visits were performed every 3 months after the stopping of anti-TNF treatment or earlier in cases of suspected relapse. Data relating to patients' smoking habits, previous surgery, location, perianal involvement, the presence of extraintestinal manifestation and types of biological therapy and concomitant immunosuppresion were collected. The baseline patient characteristics are outlined in Table 1.

Results

The median follow-up time was 34 months. Seven CD relapses occurred over the first year and eight during the second year, with an estimated proportion of relapse over 1 year and 2 years of 23% and 48% respectively. Of the 15 patients with recurrent CD, 11 required biological treatment to control the relapse with an adequate response observed in 91% of cases.

Ileal disease, high ASCA levels, fecal calprotectin above 250 over the follow-up and a history of prior surgery were significantly associated with an increased risk of recurrence. No differences were shown regarding the type on anti-TNF therapy, presence of the perianal disease and the occurrence of extraintestinal manifestations.

Table 1. Baseline characteristics of Crohn's disease patients (N = 32)
Male42%
Smokers29%
Prior surgery19%
Mean age at diagnosis29.8±2
Infliximab/Adalimumab48% / 52%
Location: Ileal (L1), colic (L2), Ileocolic (L3)51%, 17%, 32%
Follow-up treatment post anti-TNF: Aza, Mtx, 5ASA83%, 9.6%, 7.4%

Conclusion

Conclusions:

  1. Approximately 50% of patients with CD experienced a relapse within 2 years after discontinuing anti-TNF treatment.
  2. Ileal location, high ASCA levels, fecal calprotectin above 250 over the follow-up and surgical history could be considered risk factors of relapse in CD patients.