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* = Presenting author

P529 Maintenance of clinical remission in Crohn's disease patients after discontinuation of antiTNF agents: Results from a single centre cohort

R. Monterubbianesi*1, C. Papi2, A. Kohn1

1AO San Camillo Forlianini, Gastroenterology Operative Unit, Rome, Italy, 2AO S. Filippo Neri, UOC Gastroenterology, Rome, Italy

Background

To maintain therapy with antiTNF in patients in clinical remission is a debated issue. Aim of our study was to assess maintenance of remission in a cohort of Crohn's disease(CD)patients who discontinued antiTNF because of clinical benefit and to identify predictive factors of relapse. A secondary objective included the assessment of retreatment with antiTNF for relapsers

Methods

Consecutive CD patients followed in a referral centre for IBD who received infliximab(IFX)or adalimumab(ADA),for at least 12 months and discontinued the drug because in clinical remission were included. All patients had ileocolonoscopy performed before and after treatment. Variables evaluated are listed in table 1.

Results

Among 516 patients treated with antiTNF from 1999 to 2011 in our Centre, 58 patients were included. 47 received IFX and 11 ADA. Median duration of treatment was 19 months (range 13.6-26.2).Median number of IFX infusions was 11(range 9-15),median number of ADA administrations was 47(range 37-73). 66% of patients were on combo therapy with immunosuppressants(ISS). Mucosal healing was achieved in 39 patients(67%).After antiTNF discontinuation 84% of patients were maintained with ISS. Kaplan-Meier curves showed a cumulative probability of a disease free course at 1 year of 69%. 2 years after antiTNF discontinuation 48% of patients relapsed;probability of relapse was 65% after 5 years. No variables were associated with the probability of maintaining clinical remission in univariate analysis. Thirty out of 58 patients were retreated with antiTNF: 63% achieved remission, 26% experienced loss of response. Acute infusion reactions were reported by 3 patients(10%)

Demographic and clinical variablesTreatment related variables
GenderDuration of treatment
AgeChange in dose or time of administration
Duration of diseaseConcomitant treatment
Disease LocationTreatment at discontinuation of antiTNF
Perianal diseaseEndoscopy result
Previous surgery

Conclusion

In our cohort of CD patients treated with antiTNF at least for 1 year, who discontinued the treatment because in clinical remission, the probability to maintain clinical benefit at 2 years was 52%. The rate of relapse was higher in the first 2 years from withdrawal. Mucosa healing did not predict sustained clinical remission. Retreatment with antiTNF for relapsers was well tolerated and effective in the majority of patients. So,discontinuation of antiTNF therapy does not seem to be a successful strategy in half of patients. Multicentric prospective studies on predictive factors of risk are needed to identify persons with a higher probability of relapse