Journal
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY
Volume 47, Issue 5, Pages 518-527Publisher
INFORMA HEALTHCARE
DOI: 10.3109/00365521.2012.660541
Keywords
clinical outcome; Crohn's disease; inflammatory bowel disease; infliximab; relapse; remission; TNF; ulcerative colitis
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Funding
- Aase and Ejnar Danielsen's Foundation
- Beckett Foundation
- Danish Colitis-Crohn Society
- Danish Medical Association Research Foundation
- Frode V. Nyegaard and wife's Foundation
- Health Science Research Foundation of Region of Copenhagen
- Herlev Hospital Research Council
- Lundbeck Foundation
- P. Carl Petersens Foundation
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Objective. To investigate duration of remission, including risk factors for relapse and response to retreatment with infliximab (IFX), in patients with Crohn's disease (CD) and ulcerative colitis (UC) who had discontinued IFX while in clinical remission. Methods. Observational, single-center, retrospective study of all patients with a primary response to IFX who discontinued IFX therapy while in steroid-free remission. Relapse was defined as reintroduction of treatment with a biologic, systemic steroid or surgery. Results. Of 219, 53 (24%) CD patients, and 28 of 97 (30%) UC patients discontinued IFX while in clinical steroid-free remission. The proportion of patients in remission declined steadily with 61% of CD patients, and 75% of UC patients being in remission after 1 year. Half the patients maintained remission after median 2 years (680 days (412-948)) and 3.5 years (1334 days (995-1673)), respectively; p = 0.057. Twelve percent with CD and 40% with UC were in remission at the end of follow-up after 10 and 4.5 years, respectively. Longer disease duration was associated with relapse in univariate analysis in CD, OR 1.1 (1.0-1.1), p = 0.022. Of 25, 24 CD patients (96%), and 5 of 7 UC patients (71%) experienced complete clinical remission when retreated with IFX after relapse. Conclusion. While the short-term prognosis seems favorable, the majority of patients who discontinue IFX while in remission relapse over time. The response to retreatment with IFX at relapse seems favorable in this subpopulation.
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