Madrid, Spain.
Pamplona, Spain.
Aliment Pharmacol Ther. 2021 Jun;53(12):1277-1288. doi: 10.1111/apt.16361. Epub 2021 May 7.
The long-term outcome of patients after antitumour necrosis factor alpha (anti-TNF) discontinuation is not well known.
To assess the risk of relapse in the long-term after anti-TNF discontinuation.
This was an extension of the evolution after anti-TNF discontinuation in patients with inflammatory bowel disease (EVODIS) study (Crohn's disease or ulcerative colitis patients treated with anti-TNFs in whom these drugs were withdrawn after achieving clinical remission) based in the same cohort of patients whose outcome was updated. Clinical remission was defined as a Harvey-Bradshaw index ≤4 points in Crohn's disease, a partial Mayo score ≤2 in ulcerative colitis and the absence of fistula drainage despite gentle finger compression in perianal disease.
This was an observational, retrospective, multicenter study. A total of 1055 patients were included. The median follow-up time was 34 months. The incidence rate of relapse was 12% per patient-year (95% confidence interval [CI] = 11-14). The cumulative incidence of relapse was 50% (95% CI = 47-53): 19% at one year, 31% at 2 years, 38% at 3 years, 44% at 4 years and 48% at 5 years of follow-up. Of the 60% patients retreated with the same anti-TNF after relapse, 73% regained remission. Of the 75 patients who did not respond, 48% achieved remission with other therapies. Of the 190 patients who started other therapies after relapse, 62% achieved remission with the new treatment.
A significant proportion of patients who discontinued the anti-TNF remained in remission. In case of relapse, retreatment with the same anti-TNF was usually effective. Approximately half of the patients who did not respond after retreatment achieved remission with other therapies.
抗肿瘤坏死因子α(anti-TNF)停药后患者的长期结局尚不清楚。
评估抗 TNF 停药后长期复发的风险。
这是炎症性肠病(EVODIS)研究中抗 TNF 停药后演变的扩展研究(在达到临床缓解后停用 TNF 治疗的 Crohn 病或溃疡性结肠炎患者),该研究基于同一队列患者的结果进行了更新。临床缓解定义为 Crohn 病的 Harvey-Bradshaw 指数≤4 分,溃疡性结肠炎的部分 Mayo 评分≤2 分,以及肛周疾病经轻柔手指按压后无瘘管引流。
这是一项观察性、回顾性、多中心研究。共纳入 1055 例患者。中位随访时间为 34 个月。复发的发生率为 12%/患者年(95%可信区间 [CI]:11-14)。复发的累积发生率为 50%(95%CI:47-53):1 年时为 19%,2 年时为 31%,3 年时为 38%,4 年时为 44%,5 年时为 48%。在 60%复发后用相同的抗 TNF 进行再治疗的患者中,73%恢复缓解。在 75 名对再治疗无反应的患者中,48%的患者用其他治疗方法缓解。在 190 例复发后开始其他治疗的患者中,62%的患者用新治疗缓解。
相当一部分停用抗 TNF 的患者仍处于缓解状态。在复发的情况下,用相同的抗 TNF 进行再治疗通常是有效的。大约一半在再治疗后无反应的患者用其他治疗方法缓解。