Infliximab discontinuation links to relapse in patients with ulcerative colitis
Click Here to Manage Email Alerts
Discontinued long-term use of infliximab correlated with lower rates of maintained remission in patients with ulcerative colitis, according to research published in The Lancet Gastroenterology and Hepatology.
“Infliximab is an anti-tumor necrosis factor antibody and is one of the most widely used therapies in patients who are corticosteroid-refractory. Maintenance administration every 8-weeks is the standard protocol because of the frequent development of antibodies to infliximab on episodic treatment,” Taku Kobayashi, MD, Center for Advanced IBD Research and Treatment at Kitasato University Kitasato Institute Hospital in Tokyo, Japan, and colleagues wrote. “However, as the number of patients receiving maintenance treatment with infliximab is increasing, questions have arisen regarding whether infliximab could be discontinued in some patients.”
In a multicenter, open-label trial, researchers investigated the outcomes of discontinued infliximab use in patients with UC in remission. They randomly assigned patients 1:1 to either continue infliximab use (n = 46) or discontinue infliximab use (n = 46) and compared remission rates.
At 48 weeks, 80.4% (95% CI, 66.1-90.6) of patients in the infliximab-continued group and 54.3% (95% CI, 39-69.1) of patients in the infliximab-discontinued group were in remission. The between-group remission rate difference was 26.1% (95% CI, 7.7-44.5). Among relapsed patients in the infliximab-discontinued group, 57% received retreatment with infliximab and 66.7% of those patients (95% CI, 34.9-90.1) achieved remission at 8-weeks. Investigators reported one or more adverse event in 17% of patients in the infliximab-continued group and 13% of patients in the infliximab-discontinued group (between-group difference: 3.9%; 95% CI, 10.3-18.1).
“Discontinuing infliximab resulted in significantly more relapse at 1-year than did continuing treatment,” Kobayashi and colleagues concluded. “Remaining subtle inflammation, as estimated based on C-reactive protein and histological inflammation (ie, the Nancy index) might be predictive for future relapse.”
Perspective
Back to Top
Treatment cessation is a very "hot" topic as many of our patients are young patients diagnosed with a chronic illness who receive much needed therapies with substantial potential adverse effects.
The finding that the histological index (especially that it was established blinded to clinical and endoscopic data) was more predictive of relapse, compared with endoscopic score, is very interesting. We know we should consider treatment cessation in patients who have experienced several years of deep (clinical and endoscopic) remission. However, perhaps we should also opt for histological remission.
Future studies would assist us to determine the optimal time-point for therapy cessation, explore outcomes of therapy cessation of other biologics and perhaps determine an intensified follow-up protocol for those patients.
Collapse
Read more about
Click Here to Manage Email Alerts