Chauvin Armelle, Le Thuaut Aurelie, Belhassan Mehdi, Le Baleur Yann, Mesli Farida, Bastuji-Garin Sylvie, Delchier Jean Charles, Amiot Aurelien
Assistance Publique-Hôpitaux de Paris (APHP), Paris Est Creteil University (UPEC), Henri Mondor Hospital, Department of Gastroenterology, Creteil, France.
Paris Est Creteil University (UPEC), Laboratory of Clinical Investigation (LIC, EA 4393), Creteil, France; Assistance Publique-Hôpitaux de Paris (APHP), Henri Mondor Hospital, Department of Public Health, Creteil, France; Assistance Publique-Hôpitaux de Paris (APHP), Henri Mondor Hospital, Clinical Research Unit (URC Mondor), Creteil, France.
Dig Liver Dis. 2014 Aug;46(8):695-700. doi: 10.1016/j.dld.2014.04.012. Epub 2014 Jun 2.
Infliximab withdrawal in patients with Crohn's disease on concomitant antimetabolite therapy is considered to be superior if obtained after a maintenance therapy period compared to induction alone.
We retrospectively analyzed the outcome of Crohn's disease patients treated with infliximab and an antimetabolite after infliximab was withdrawn using induction alone or induction plus at least 1-year of maintenance therapy. The time to relapse was analyzed using univariate and multivariate analyses. The model was adjusted according to the period of infliximab withdrawal.
A total of 92 patients were included, 54 in the induction alone group. The patient characteristics were identical in the two groups except for the period of infliximab withdrawal. After a median follow-up period of 47.1 (interquartile range=4.4-110.2) months, 66 patients (72%) experienced a relapse. After a year-adjustment, no significant difference was observed between the two groups. Based on year-adjusted multivariate analysis, the risk factors for relapse were active smoking, previous antimetabolite failure, and perianal disease. After relapse, 53 patients (80%) were retreated with infliximab. After infliximab retreatment, clinical remission was observed in 47 patients (89%) at weeks 8-10.
In Crohn's disease patients, the probability of relapse on antimetabolite therapy after infliximab withdrawal was not superior after a 1-year scheduled maintenance therapy as compared with an induction alone.
对于正在接受抗代谢物联合治疗的克罗恩病患者，与仅采用诱导治疗相比，在维持治疗期后停用英夫利昔单抗被认为更具优势。
我们回顾性分析了仅采用诱导治疗或诱导治疗加至少1年维持治疗后停用英夫利昔单抗的克罗恩病患者的治疗结局。采用单因素和多因素分析方法分析复发时间。根据英夫利昔单抗停药时间对模型进行调整。
共纳入92例患者，仅采用诱导治疗组54例。除英夫利昔单抗停药时间外，两组患者特征相同。中位随访期47.1（四分位间距=4.4-110.2）个月后，66例患者（72%）复发。经过一年调整后，两组间未观察到显著差异。基于一年调整后的多因素分析，复发的危险因素为现吸烟、既往抗代谢物治疗失败和肛周疾病。复发后，53例患者（80%）再次接受英夫利昔单抗治疗。再次使用英夫利昔单抗治疗后，8-10周时47例患者（89%）实现临床缓解。
对于克罗恩病患者，与仅采用诱导治疗相比，在1年的计划维持治疗后停用英夫利昔单抗，接受抗代谢物治疗时的复发概率并无优势。
