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P314 Proposal for an anti-tumour necrosis factor–exit strategy based on trough serum level

U. Helwig*1, F. Lutter1, N. Koppka2, S. Schreiber3

1University of Kiel, Medical Practice for Internal Medicine, Oldenburg, Germany, 2Medical Practice for Internal Medicine, Oldenburg, Germany, 3Department of Internal Medicine I - Gastroenterology, Hepatology, Nutrition and Geriatric Medicine, University Hospital Schleswig-Holstein, campus Kiel, Kiel, Germany


Discontinuation of anti-tumour necrosis factor (TNF) therapy in deep remission exhibits high relapse rates. Some parameters have been explored that might influence the outcome of cessation. Beside parameters of inflammation, high trough serum levels of infliximab have been reported as a risk factor for a relapse. The aim of the study was to evaluate if the strategy to stop anti-TNF treatment after determination of low trough serum levels and exclusion of inflammation is associated with lower relapse rates.


Since 2013 we followed an exit strategy in patients treated with anti-TNF treatment for inflammatory bowel disease (IBD), based on trough serum levels. The relapse rates were observed prospectively, data analysis was performed in a retrospective manner of the collected clinical data. Patients, who stopped anti-TNF therapy were used as a control group


Thirty patients were enrolled, who stopped anti-TNF therapy: 8 Patients followed the clinical algorithm; 22 patients were used as control group (11 patients with ulcerative colitis and 19 patients with Crohn’s disease). Further, 13 patients received infliximab, and 17 adalimumab. The median follow-up time after discontinuation was 21 months (IQR 15.5). Relapses were observed in 15/30 patients (50%). Amongst the 8 patients with a targeted discontinuation of therapy based on the algorithm, 1 relapse was observed (13%), compared with 14/22 (64%) from the non-algorithm group (OR 12.3; 95% CI, 1.3–118.4). Relapse-free-survival after anti-TNF-discontinuation was significantly higher in patients treated by the algorithm compared with the non-algorithm-group (p = 0.048).


Exit strategy based on trough serum levels minimises the relapse rate of IBD significantly.

Figure 1. Percentage of relapse after discontinuation of anti-TNF under clinical remission.

Comparing patients followed the algorithm with a low TSL to the Non-algorithm with a high TSL.

TSL, trough serum level.