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IBD patients in long-term remission with undetectable anti-TNF levels avoid relapse after drug discontinuation
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Patients with inflammatory bowel disease who discontinued anti-tumor necrosis factor therapy while in long-term remission were less likely to relapse if they had incidental undetectable drug levels, according to results from a retrospective cohort study.
To determine if anti-TNF drug levels are predictive of relapse after drug discontinuation in IBD patients who are in long-term remission, researchers identified patients (Crohn’s disease, n = 30; ulcerative colitis, n = 18) from two tertiary centers in France and Israel who received infliximab (n = 35) or adalimumab (n = 13) from 2009 to December 2014 and discontinued maintenance therapy (median duration, 21 [IQR, 13-26.5] months) while in remission.
All patients had levels of anti-TNF drug and antidrug antibodies within 2 months of drug discontinuation available, and the primary outcome was duration of relapse-free survival in patients with detectable vs. undetectable drug levels.
Active inflammation was absent in 95% of patients who underwent endoscopy or MRI enterography before drug discontinuation, and C-reactive protein and calprotectin levels were normal in 65% of patients.
Relapse occurred in 80% of the 20 patients who discontinued anti-TNF with measurable drug levels compared with 32% of the 28 patients who discontinued anti-TNF with undetectable drug levels (OR = 8.4; 95% CI, 2.2-32; median follow-up, 12 months). Patients with undetectable drug levels had longer relapse-free survival (P < .001). Multivariate analysis showed normal biomarkers (OR = 0.07; 95% CI, 0.01-0.5) and undetectable drug levels (OR = 0.06; 95% CI, 0.01-0.4) were independently associated with absence of relapse, while a patient’s decision (rather than a physician’s) to discontinue drug was weakly associated with risk for relapse (OR = 32; 95% CI, 1.5-717).
“In conclusion, the present study shows that patients in long-lasting deep remission found to have persistent absent anti-TNF drug levels are a unique subset of patients with low risk of disease relapse upon drug discontinuation,” the researchers wrote. “It also shows that even for these patients with mucosal healing, a very low calprotectin level still has discriminatory predictive value for future relapse.” – by Adam Leitenberger
Disclosure: Ben-Horin reports he received consulting and advisory board fees and/or research support from AbbVie, MSD, Janssen, Takeda and Celltrion. Please see the study for a full list of all other researchers’ relevant financial disclosures.
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