Little is known about long-term outcomes of patients with Crohn’s disease after infliximab withdrawal.
Dr Reenaers and colleagues of Belgium described the long-term outcomes of patients with Crohn’s disease in clinical remission after infliximab treatment was withdrawn.
The doctors performed a retrospective analysis of data from the 115 patients included in the infliximab discontinuation in patients with Crohn’s disease in stable remission on combined therapy with antimetabolites study, performed at 20 centers in France and Belgium from 2006 through 2009.
The infliximab discontinuation in Crohn's disease patients in stable remission on combined therapy with immunosuppressors cohort was a prospective analysis of risk and factors associated with relapse following withdrawal of maintenance therapy with infliximab, maintained on antimetabolites, while in clinical remission.
The researchers collected data from the end of the study until the last available follow-up examination on patient surgeries, new complex perianal lesions and need for and outcomes of restarting therapy with infliximab or another biologic agent.
The de-escalation strategy was considered to have failed when a major complication or infliximab restart failure occurred.
Of the 115 patients initially included, data from 102 patients were included in the final analysis.
Major complications occurred in 19% of patients
|Clinical Gastroenterology and Hepatology
The median follow-up time was 7 years.
The team found that 21% of the patients did not restart treatment with infliximab or another biologic agent, and did not have a major complication 7 years after infliximab withdrawal.
Among patients who restarted infliximab, treatment failed for 30% at 6 years after restarting.
Overall, at 7 years after stopping infliximab therapy, major complications occurred in 19% of patients whereas 70% of patients had no failure of the de-escalation strategy.
The research team observed that factors independently associated with major complications were upper-gastrointestinal location of disease, white blood cell count ≥ 5.0 × 109/L, and hemoglobin level ≤12.5 g/dL at the time of infliximab withdrawal.
Patients with at least 2 of these factors had a more than 40% risk of major complication in the 7 years following infliximab withdrawal.
Dr Reenaers' concludes, "In a long-term follow-up of the infliximab discontinuation in Crohn's disease patients in stable remission on combined therapy with immunosuppressors cohort one fifth of the patients did not restart infliximab or another biologic agent and did not develop major complications."
"Seventy percent of patients had no failure of the de-escalation strategy."