炎症性肠病深度缓解患者停用 TNFα 阻断治疗后的结局。
Outcome after discontinuation of TNFα-blocking therapy in patients with inflammatory bowel disease in deep remission.
机构信息
*Department of Medicine, Division of Gastroenterology, Maria Helsinki City Hospital and University of Helsinki, Helsinki, Finland; †Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland; ‡Division of Gastroenterology, Department of Medicine, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland; §Department of Medicine, Division of Gastroenterology, Turku University Central Hospital, Turku, Finland; ‖Department of Medicine, Division of Gastroenterology, Oulu University Central Hospital, Oulu, Finland; ¶Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; **Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland; ††Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Peijas Hospital, Vantaa, Finland; ‡‡Department of Medicine, Hyvinkää Hospital, Hyvinkää, Finland; §§Department of Medicine, Porvoo Hospital, Porvoo, Finland; ‖‖Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland; and ¶¶Department of Surgery, Helsinki University Central Hospital, Biomedicum Helsinki, Finland.
出版信息
Inflamm Bowel Dis. 2014 Jun;20(6):1021-8. doi: 10.1097/MIB.0000000000000052.
BACKGROUND
Few data are available on the disease course in patients with inflammatory bowel disease (IBD) in deep remission after discontinuing tumor necrosis factor α (TNFα)-blocking therapy. In this prospective multicenter study, we evaluated the relapse rate, predictive factors, and the response to retreatment after discontinuation of TNFα-blocking therapy in patients with IBD in deep remission.
METHODS
We recruited 52 patients (17 Crohn's disease, 30 ulcerative colitis, and 5 IBD unclassified) in clinical, endoscopic, and fecal calprotectin-based (<100 μg/g) remission after at least 1 year of TNFα-blocking therapy. Clinical and endoscopic remission and relapse were defined according to validated indices. After discontinuation of therapy, the patients were followed up with endoscopic assessment at 4 and 12 months. In the event of a clinical relapse with endoscopically active disease or minor clinical symptoms but severe endoscopic relapse, TNFα-blocking therapy was restarted.
RESULTS
After a median follow-up time of 13 (range, 12-15) months, 17/51 (33%) patients relapsed (5/17 Crohn's disease, 12/34 ulcerative colitis/IBD unclassified, 1 patient lost to follow-up at 6 mo). Ten experienced clinical and endoscopic relapse, 5 clinical relapse with mild endoscopic activity, and 2 severe endoscopic relapse. No specific predictive factors were associated with the relapse. Retreatment was effective in 94% of patients.
CONCLUSIONS
After cessation of TNFα-blocking therapy in patients with IBD in deep remission, up to 67% remained in clinical remission during the 12-month follow-up. Importantly, 85% of these patients sustained endoscopic remission. The response to restart of TNFα antagonists was effective and well tolerated.
背景
在停止肿瘤坏死因子 α（TNFα）阻断治疗后处于深度缓解的炎症性肠病（IBD）患者的疾病进程数据有限。在这项前瞻性多中心研究中，我们评估了深度缓解的 IBD 患者停止 TNFα 阻断治疗后复发率、预测因素和再治疗反应。
方法
我们招募了 52 名患者（17 名克罗恩病、30 名溃疡性结肠炎和 5 名 IBD 未分类），他们在接受 TNFα 阻断治疗至少 1 年后达到临床、内镜和粪便钙卫蛋白（<100μg/g）缓解。根据验证的指标定义了临床和内镜缓解和复发。停止治疗后，患者在 4 个月和 12 个月时进行内镜评估。如果出现内镜活动疾病或轻微临床症状但严重内镜复发的临床复发，则重新开始 TNFα 阻断治疗。
结果
在中位随访时间为 13（范围，12-15）个月后，51 名患者中有 17 名（33%）复发（5/17 克罗恩病、12/34 溃疡性结肠炎/ IBD 未分类、1 名患者在 6 个月时失访）。10 名患者出现临床和内镜复发，5 名患者出现临床复发但内镜活动轻微，2 名患者出现严重内镜复发。没有特定的预测因素与复发相关。再治疗在 94%的患者中有效。
结论
在深度缓解的 IBD 患者停止 TNFα 阻断治疗后，在 12 个月的随访中，多达 67%的患者仍处于临床缓解状态。重要的是，85%的患者维持内镜缓解。重新开始 TNFα 拮抗剂的反应有效且耐受良好。
Zotero 插件