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P401. Outcome of infliximab discontinuation in IBD patients and therapy rechallenging in relapsers: Single centre preliminary data

M. Marino, E. Zucchi, M. Fabbro, I. Lodolo, R. Maieron, S. Vadalà, M. Zilli, University Hospital S. M. della Misericordia, Gastroenterology, Udine, Italy

Background

Tumor necrosis factor antagonists (TNF-A) have dramatically changed our concept of treating inflammatory bowel disease (IBD). One of the ongoing controversies, still debated, is whether and when stop treatment with TNF antagonists but nowadays there are scant data about this important issue. Moreover there are few studies on the rechallenging response to the same drug when IBD relapses at suspension of TNF-A. Aim of this study is to investigate relapses in IBD patients after withdrawal of infliximab (IFX) and evaluate the effectiveness of rechallenge on clinical and biochemical bases.

Methods

In this observational, retrospective, single centre study, from Jan 2010 til Oct 2013 we made a long-term evaluation of IBD patients (Crohn's disease [CD], Ulcerative colitis [UC]) who discontinued the maintaining therapy with IFX. All infusions are registered and clinical data recorded for each patient.

Results

On 37 patients in IFX maintenance therapy, 18 subjects (male 9/18) discontinued IFX (49%). The mean age was 46.42 y.o. with CD present in 74% and UC in 26% of the subjects. The reasons of IFX interruption were: cancer in 1/18 (6%), deep remission in 10/18 (55%), clinical response in 1/18 (6%), severe allergic reaction 1/18 (6%), lack of response 3/18 (17%), surgery 2/18 (11%). Considering only subjects in deep remission (minimum one year of IFX treatment), 4 of them (2 CD and 2 UC, 40% of the total) have persistent remission after a mean time of 20 months (rand 11–28 months). The remaining 6 subject, all affected by CD, flared-up in a mean time of 14 months (SD ±8, range 7–22 months). In the group with persistent remission, 3 of 4 subjects were, respectively, one in azathioprine and the other two in masalamine. In the relapser group (60%), 4 had no bridge therapy at suspension, one was in azathioprine and one in sulfasalazine. All relapsers were re-treated with Infliximab; all of them had clinical response at rechallenge.

Conclusion

Of IBD patients in deep remission at the time of cessation of IFX therapy, 40% had sustained remission during our follow-up. All subjects who relapsed had a clinical response to reintroduction of IFX. Our data implies that some patients may achieve prolonged remission after IFX discontinuation and in those who flared-up, reintroduction of IFX seems to be very effective and well tolerated.