Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Statistics and Data Center, Samsung Medical Center, Seoul, Korea.
Sci Rep. 2022 Jan 11;12(1):507. doi: 10.1038/s41598-021-04304-6.
Few studies have demonstrated treatment strategies about the duration and cessation of medications in patients with Crohn's disease (CD). We investigated factors affecting clinical relapse after infliximab (IFX) or azathioprine (AZA) withdrawal in pediatric patients with CD on combination therapy. Pediatric patients with moderate-to-severe CD receiving combination therapy were analyzed retrospectively and factors associated with clinical relapse were investigated. Discontinuation of IFX or AZA was performed in patients who sustained clinical remission (CR) for at least two years and achieved deep remission. A total of 75 patients were included. Forty-four patients (58.7%) continued with combination therapy and 31 patients (41.3%) discontinued AZA or IFX (AZA withdrawal 10, IFX withdrawal 15, both withdrawal 6). Cox proportional-hazards regression and statistical internal validation identified three factors associated with clinical relapse: IFX cessation (hazard ratio; HR 2.982, P = 0.0081), IFX TLs during maintenance therapy (HR 0.581, P = 0.003), 6-thioguanine nucleotide (6-TGN) level (HR 0.978, P < 0.001). However, AZA cessation was not associated with clinical relapse (P = 0.9021). Even when applied in pediatric patients who met stringent criteria, IFX cessation increased the relapse risk. However, withdrawal of AZA could be contemplated in pediatric patients with CD who have sustained CR for at least 2 years and achieved deep remission.
很少有研究表明克罗恩病（CD）患者药物治疗的持续时间和停药策略。我们研究了在接受英夫利昔单抗（IFX）或硫唑嘌呤（AZA）联合治疗的 CD 儿科患者中，停药后临床复发的影响因素。回顾性分析接受联合治疗的中重度 CD 儿科患者，并研究与临床复发相关的因素。IFX 或 AZA 的停药是在持续缓解至少 2 年且达到深度缓解的患者中进行的。共纳入 75 例患者。44 例（58.7%）继续接受联合治疗，31 例（41.3%）停用 AZA 或 IFX（AZA 停药 10 例，IFX 停药 15 例，两者均停药 6 例）。Cox 比例风险回归和统计内部验证确定了与临床复发相关的三个因素：IFX 停药（风险比；HR 2.982，P=0.0081）、维持治疗期间的 IFX TLs（HR 0.581，P=0.003）、6-硫鸟嘌呤核苷酸（6-TGN）水平（HR 0.978，P<0.001）。然而，AZA 停药与临床复发无关（P=0.9021）。即使在符合严格标准的儿科患者中应用，IFX 停药也会增加复发风险。然而，对于持续缓解至少 2 年且达到深度缓解的 CD 儿科患者，可以考虑停用 AZA。
