Relapse after withdrawal from anti-TNF therapy for inflammatory bowel disease: An observational study, plus systematic review and meta-analysis

TY - JOUR

T1 - Relapse after withdrawal from anti-TNF therapy for inflammatory bowel disease

T2 - An observational study, plus systematic review and meta-analysis

AU - UK Anti-TNF withdrawal study group

AU - Kennedy, N. A.

AU - Warner, B.

AU - Johnston, E. L.

AU - Flanders, L.

AU - Hendy, P.

AU - Ding, N. S.

AU - Harris, R.

AU - Fadra, A. S.

AU - Basquill, C.

AU - Lamb, C. A.

AU - Cameron, F. L.

AU - Murray, C. D.

AU - Parkes, M.

AU - Gooding, I.

AU - Ahmad, T.

AU - Gaya, D. R.

AU - Mann, S.

AU - Lindsay, J. O.

AU - Gordon, J.

AU - Satsangi, J.

AU - Hart, A.

AU - McCartney, S.

AU - Irving, P.

AU - Lees, C. W.

AU - Basavaraju, Umesh

AU - Christodoulou, Christos

AU - Cummings, Fraser

AU - Grieveson, Kay

AU - Johnston, Matthew

AU - Lal, Simon

AU - Lithgo, Karen

AU - Lockett, Melanie

AU - Maggs, Daniel

AU - Mansfield, John

AU - Mason, Joy

AU - Nowell, Emma

AU - Russell, Richard K.

AU - Singh, Abhey

AU - Stansfield, Catherine

AU - Thomson, John

AU - Wilson, David C.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background Infliximab and adalimumab have established roles in inflammatory bowel disease (IBD) therapy. UK regulators mandate reassessment after 12 months' anti-TNF therapy for IBD, with consideration of treatment withdrawal. There is a need for more data to establish the relapse rates following treatment cessation. Aim To establish outcomes following anti-TNF withdrawal for sustained remission using new data from a large UK cohort, and assimilation of all available literature for systematic review and meta-analysis. Methods A retrospective observational study was performed on 166 patients with IBD (146 with Crohn's disease (CD) and 20 with ulcerative colitis [UC) and IBD unclassified (IBDU)] withdrawn from anti-TNF for sustained remission. Meta-analysis was undertaken of all published studies incorporating 11 further cohorts totalling 746 patients (624 CD, 122 UC). Results Relapse rates in the UK cohort were 36% by 1 year and 56% by 2 years for CD, and 42% by 1 year and 47% by 2 years for UC/IBDU. Increased relapse risk in CD was associated with age at diagnosis [hazard ratio (HR) 2.78 for age <22 years], white cell count (HR 3.22 for >5.25 × 109/L) and faecal calprotectin (HR 2.95 for >50 μg/g) at drug withdrawal. Neither continued immunomodulators nor endoscopic remission were predictors. In the meta-analysis, estimated 1-year relapse rates were 39% and 35% for CD and UC/IBDU respectively. Retreatment with anti-TNF was successful in 88% for CD and 76% UC/IBDU. Conclusions Assimilation of all available data reveals remarkable homogeneity. Approximately one-third of patients with IBD flare within 12 months of withdrawal of anti-TNF therapy for sustained remission.

AB - Background Infliximab and adalimumab have established roles in inflammatory bowel disease (IBD) therapy. UK regulators mandate reassessment after 12 months' anti-TNF therapy for IBD, with consideration of treatment withdrawal. There is a need for more data to establish the relapse rates following treatment cessation. Aim To establish outcomes following anti-TNF withdrawal for sustained remission using new data from a large UK cohort, and assimilation of all available literature for systematic review and meta-analysis. Methods A retrospective observational study was performed on 166 patients with IBD (146 with Crohn's disease (CD) and 20 with ulcerative colitis [UC) and IBD unclassified (IBDU)] withdrawn from anti-TNF for sustained remission. Meta-analysis was undertaken of all published studies incorporating 11 further cohorts totalling 746 patients (624 CD, 122 UC). Results Relapse rates in the UK cohort were 36% by 1 year and 56% by 2 years for CD, and 42% by 1 year and 47% by 2 years for UC/IBDU. Increased relapse risk in CD was associated with age at diagnosis [hazard ratio (HR) 2.78 for age <22 years], white cell count (HR 3.22 for >5.25 × 109/L) and faecal calprotectin (HR 2.95 for >50 μg/g) at drug withdrawal. Neither continued immunomodulators nor endoscopic remission were predictors. In the meta-analysis, estimated 1-year relapse rates were 39% and 35% for CD and UC/IBDU respectively. Retreatment with anti-TNF was successful in 88% for CD and 76% UC/IBDU. Conclusions Assimilation of all available data reveals remarkable homogeneity. Approximately one-third of patients with IBD flare within 12 months of withdrawal of anti-TNF therapy for sustained remission.

UR - http://www.scopus.com/inward/record.url?scp=84959094475&partnerID=8YFLogxK

U2 - 10.1111/apt.13547

DO - 10.1111/apt.13547

M3 - Article

C2 - 26892328

AN - SCOPUS:84959094475

SN - 0269-2813

VL - 43

SP - 910

EP - 923

JO - Alimentary Pharmacology & Therapeutics

JF - Alimentary Pharmacology & Therapeutics

IS - 8

ER -