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Maintenance of remission among patients with Crohn's disease on antimetabolite therapy after infliximab therapy is stopped

Edouard Louis, Jean-Yves Mary, Gwenola Vernier-Massouille, Jean-Charles Grimaud, Yoram Bouhnik, David Laharie, Jean-Louis Dupas, Hélène Pillant, Laurence Picon and Michel Veyrac, et al. (2012) GASTROENTEROLOGY. 142(1). p.63-70
abstract
BACKGROUND & AIMS: It is important to determine whether infliximab therapy can be safely interrupted in patients with Crohn's disease who have undergone a period of prolonged remission. We assessed the risk of relapse after infliximab therapy was discontinued in patients on combined maintenance therapy with antimetabolites and identified factors associated with relapse. METHODS: We performed a prospective study of 115 patients with Crohn's disease who were treated for at least 1 year with scheduled infliximab and an antimetabolite and had been in corticosteroid-free remission for at least 6 months. Infliximab was stopped, and patients were followed up for at least 1 year. We associated demographic, clinical, and biologic factors with time to relapse using a Cox model. RESULTS: After a median follow-up period of 28 months, 52 of the 115 patients experienced a relapse; the 1-year relapse rate was 43.9% +/- 5.0%. Based on multivariable analysis, risk factors for relapse included male sex, the absence of surgical resection, leukocyte counts >6.0 x 10(9)/L, and levels of hemoglobin <= 145 g/L, C-reactive protein >= 5.0 mg/L, and fecal calprotectin >= 300 mu g/g. Patients with no more than 2 of these risk factors (approximately 29% of the study population) had a 15% risk of relapse within 1 year. Re-treatment with infliximab was effective and well tolerated in 88% of patients who experienced a relapse. CONCLUSIONS: Approximately 50% of patients with Crohn's disease who were treated for at least 1 year with infliximab and an antimetabolite agent experienced a relapse within 1 year after discontinuation of infliximab. However, patients with a low risk of relapse can be identified using a combination of clinical and biologic markers.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
INDUCTION, EFFICACY, ANTIBODIES, WITHDRAWAL, RANDOMIZED-TRIAL, INFLAMMATORY-BOWEL-DISEASE, PROPORTIONAL-HAZARDS REGRESSION, Clinical TrialStopping Therapy Factors That Contribute to Relapse, Inflammatory Bowel Disease, IBD, MODEL, INDEX
journal title
GASTROENTEROLOGY
Gastroenterology
volume
142
issue
1
pages
63 - 70
Web of Science type
Article
Web of Science id
000298250800030
JCR category
GASTROENTEROLOGY & HEPATOLOGY
JCR impact factor
12.821 (2012)
JCR rank
1/73 (2012)
JCR quartile
1 (2012)
ISSN
0016-5085
DOI
10.1053/j.gastro.2011.09.034
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2018756
handle
http://hdl.handle.net/1854/LU-2018756
date created
2012-02-03 13:55:20
date last changed
2013-02-26 11:07:13
@article{2018756,
  abstract     = {BACKGROUND \& AIMS: It is important to determine whether infliximab therapy can be safely interrupted in patients with Crohn's disease who have undergone a period of prolonged remission. We assessed the risk of relapse after infliximab therapy was discontinued in patients on combined maintenance therapy with antimetabolites and identified factors associated with relapse.
METHODS: We performed a prospective study of 115 patients with Crohn's disease who were treated for at least 1 year with scheduled infliximab and an antimetabolite and had been in corticosteroid-free remission for at least 6 months. Infliximab was stopped, and patients were followed up for at least 1 year. We associated demographic, clinical, and biologic factors with time to relapse using a Cox model.
RESULTS: After a median follow-up period of 28 months, 52 of the 115 patients experienced a relapse; the 1-year relapse rate was 43.9\% +/- 5.0\%. Based on multivariable analysis, risk factors for relapse included male sex, the absence of surgical resection, leukocyte counts {\textrangle}6.0 x 10(9)/L, and levels of hemoglobin {\textlangle}= 145 g/L, C-reactive protein {\textrangle}= 5.0 mg/L, and fecal calprotectin {\textrangle}= 300 mu g/g. Patients with no more than 2 of these risk factors (approximately 29\% of the study population) had a 15\% risk of relapse within 1 year. Re-treatment with infliximab was effective and well tolerated in 88\% of patients who experienced a relapse.
CONCLUSIONS: Approximately 50\% of patients with Crohn's disease who were treated for at least 1 year with infliximab and an antimetabolite agent experienced a relapse within 1 year after discontinuation of infliximab. However, patients with a low risk of relapse can be identified using a combination of clinical and biologic markers.},
  author       = {Louis, Edouard and Mary, Jean-Yves and Vernier-Massouille , Gwenola and Grimaud , Jean-Charles and Bouhnik, Yoram and Laharie, David and Dupas, Jean-Louis and Pillant, H{\'e}l{\`e}ne and Picon , Laurence and Veyrac, Michel and Flamant, Mathurin and Savoye, Guillaume and Jian , Raymond and De Vos, Martine and Porcher, Rapha{\"e}l and Paintaud , Gilles and Piver , Eric and Colombel, Jean-Fr{\'e}d{\'e}ric and Lemann , Marc},
  issn         = {0016-5085},
  journal      = {GASTROENTEROLOGY},
  keyword      = {INDUCTION,EFFICACY,ANTIBODIES,WITHDRAWAL,RANDOMIZED-TRIAL,INFLAMMATORY-BOWEL-DISEASE,PROPORTIONAL-HAZARDS REGRESSION,Clinical TrialStopping Therapy Factors That Contribute to Relapse,Inflammatory Bowel Disease,IBD,MODEL,INDEX},
  language     = {eng},
  number       = {1},
  pages        = {63--70},
  title        = {Maintenance of remission among patients with Crohn's disease on antimetabolite therapy after infliximab therapy is stopped},
  url          = {http://dx.doi.org/10.1053/j.gastro.2011.09.034},
  volume       = {142},
  year         = {2012},
}

Chicago
Louis, Edouard, Jean-Yves Mary, Gwenola Vernier-Massouille , Jean-Charles Grimaud , Yoram Bouhnik, David Laharie, Jean-Louis Dupas, et al. 2012. “Maintenance of Remission Among Patients with Crohn’s Disease on Antimetabolite Therapy After Infliximab Therapy Is Stopped.” Gastroenterology 142 (1): 63–70.
APA
Louis, E., Mary, J.-Y., Vernier-Massouille , G., Grimaud , J.-C., Bouhnik, Y., Laharie, D., Dupas, J.-L., et al. (2012). Maintenance of remission among patients with Crohn’s disease on antimetabolite therapy after infliximab therapy is stopped. GASTROENTEROLOGY, 142(1), 63–70.
Vancouver
1.
Louis E, Mary J-Y, Vernier-Massouille G, Grimaud J-C, Bouhnik Y, Laharie D, et al. Maintenance of remission among patients with Crohn’s disease on antimetabolite therapy after infliximab therapy is stopped. GASTROENTEROLOGY. 2012;142(1):63–70.
MLA
Louis, Edouard, Jean-Yves Mary, Gwenola Vernier-Massouille , et al. “Maintenance of Remission Among Patients with Crohn’s Disease on Antimetabolite Therapy After Infliximab Therapy Is Stopped.” GASTROENTEROLOGY 142.1 (2012): 63–70. Print.