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

UK Anti-TNF withdrawal study group, N. A. Kennedy, B. Warner, E. L. Johnston, L. Flanders, P. Hendy, N. S. Ding, R. Harris, A. S. Fadra, C. Basquill, C. A. Lamb, F. L. Cameron, C. D. Murray, M. Parkes, I. Gooding, T. Ahmad, D. R. Gaya, S. Mann, J. O. Lindsay, J. GordonJ. Satsangi, A. Hart, S. McCartney, P. Irving, C. W. Lees*, Umesh Basavaraju, Christos Christodoulou, Fraser Cummings, Kay Grieveson, Matthew Johnston, Simon Lal, Karen Lithgo, Melanie Lockett, Daniel Maggs, John Mansfield, Joy Mason, Emma Nowell, Richard K. Russell, Abhey Singh, Catherine Stansfield, John Thomson, David C. Wilson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

89 Citations (Scopus)

Abstract

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166 patients with IBD (146 with Crohn's disease (CD) and 20 with ulcerative colitis [UC) and IBD unclassified (IBDU)] withdrawn from anti-TNF for sustained remission.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.

Original languageEnglish
Pages (from-to)910-923
Number of pages14
JournalAlimentary Pharmacology and Therapeutics
Volume43
Issue number8
Early online date19 Feb 2016
DOIs
Publication statusPublished - 1 Apr 2016

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