Systematic review: factors associated with relapse of inflammatory bowel disease after discontinuation of anti‐TNF therapy

• Published in: Alimentary pharmacology & therapeutics 2015-08, Vol.42 (4), p.391-405
• Main Authors: Gisbert, J. P., Marín, A. C., Chaparro, M.
• Format: Article
• Language: English
• Subjects: Biomarkers - metabolism; C-Reactive Protein - metabolism; Colitis, Ulcerative - drug therapy; Crohn Disease - drug therapy; Feces - chemistry; Humans; Leukocyte L1 Antigen Complex - metabolism; Recurrence; Time Factors; Tumor Necrosis Factor-alpha - antagonists & inhibitors
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.13276

Summary Background The discontinuation of anti‐tumour necrosis factor (anti‐TNF) treatment in inflammatory bowel disease (IBD) patients in remission could be considered. Aim To evaluate the factors associated with relapse of IBD after discontinuation of anti‐TNF therapy. Methods Electronic (PubMed/Embase) and manual search up to January 2015. Results The overall risk of relapse after discontinuation of anti‐TNFs (27 studies) was 44% for Crohn's disease (CD; follow‐up range: 6–125 months) and 38% for ulcerative colitis (follow‐up range: 6–24 months). Several factors were investigated to identify patients who are more likely to achieve long‐lasting remission after anti‐TNF discontinuation. The factors associated with a higher risk of relapse are younger age, smoking, longer disease duration, and fistulising perianal CD. Laboratory markers such as low haemoglobin levels, high C‐reactive protein levels and high faecal calprotectin seem to increase the risk of relapse. On the other hand, low serum anti‐TNF levels seem to be associated with a lower risk of flare‐up. Mucosal healing seems to decrease the risk of relapse after anti‐TNF discontinuation (overall, this risk is 26% at 1 year with mucosal healing and 42% without), although this observation has not been confirmed by some authors. In patients receiving escalated anti‐TNF doses or receiving anti‐TNFs for the prevention of post‐operative CD recurrence, the risk of relapse after discontinuation is high (>75%). Re‐administration of the drug in those who relapsed after stopping treatment is effective and safe. Conclusions A high proportion of patients with IBD relapse after discontinuation of anti‐TNF treatment. As available data are insufficient to make strong recommendations on when anti‐TNF therapy could be stopped, decisions should be taken on an individual basis.