De-escalating therapy in inflammatory bowel disease: Results from an observational study in clinical practice

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dc.contributor.authorArenas, Alex
dc.contributor.authorMoreta, Maria Jose
dc.contributor.authorOrdas, Ingrid
dc.contributor.authorFernandez-Clotet, Agnes
dc.contributor.authorCaballol, Berta
dc.contributor.authorGallego, Marta
dc.contributor.authorVara, Alejandro
dc.contributor.authorBarastegui, Rebeca
dc.contributor.authorGiner, Angel
dc.contributor.authorPrieto, Cristina
dc.contributor.authorMasamunt, Maria Carme
dc.contributor.authorCandia, Roberto
dc.contributor.authorRicart, Elena
dc.date.accessioned2025-01-20T16:12:18Z
dc.date.available2025-01-20T16:12:18Z
dc.date.issued2024
dc.description.abstractBackground and objectives: Combination therapy with an immunomodulator (IMM) and an antiTNF is commonly recommended in Crohn's disease (CD) and ulcerative colitis (UC) patients. However, little is known about relapse rates after therapeutic de-escalation. This study aimed to evaluate the risk of relapse in a cohort of UC and CD patients with long-standing clinical remission after discontinuation of IMM or anti-TNF and to identify predictive factors for relapse. Methods: This retrospective study included patients with UC or CD on combination therapy and clinical remission for at least 6 months. IMM or anti-TNF was stopped upon physician decision. Primary objective was to evaluate the relapse rates after discontinuation of IMM or anti-TNF and to analyze predictors of relapse. Results: The study included 88 patients, 48 patients (54.5%) discontinued IMM and 40 (45.5%) anti-TNF. During follow-up, relapse rates were 16.7% and 52.5% in the IMM discontinuation group and anti-TNF discontinuation group, respectively (p < 0.001). Multivariate analysis showed that anti-TNF discontinuation (HR = 3.01; 95% CI = 1.22-7.43) and ileal CD location (HR = 2.36; 95% CI = 1.02-5.47) were predictive factors for relapse while inflammatory CD phenotype was a protective factor (HR = 0.32; 95% CI = 0.11-0.90). Reintroduction of anti-TNF upon relapse was effective and safe. Conclusion: Anti TNF discontinuation led to significantly higher relapse rates compared to IMM discontinuation in UC and CD patients on combination therapy. Anti-TNF discontinuation and ileal CD location were identified as predictive factors for relapse while inflammatory CD phenotype was a protective factor. Retreatment after anti-TNF discontinuation was effective and safe. (c) 2023ElsevierEspa na,S.L.U.Allrightsreserved.
dc.fuente.origenWOS
dc.identifier.doi10.1016/j.gastrohep.2023.07.005
dc.identifier.issn0210-5705
dc.identifier.urihttps://doi.org/10.1016/j.gastrohep.2023.07.005
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/90325
dc.identifier.wosidWOS:001277657200001
dc.issue.numero7
dc.language.isoen
dc.pagina.final682
dc.pagina.inicio673
dc.revistaGastroenterologia y hepatologia
dc.rightsacceso restringido
dc.subjectCrohn's disease
dc.subjectUlcerative colitis
dc.subjectInflammatory bowel disease
dc.subjectDiscontinuation
dc.subjectAnti-TNF
dc.subjectImmunomodulators
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleDe-escalating therapy in inflammatory bowel disease: Results from an observational study in clinical practice
dc.typeartículo
dc.volumen47
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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