在炎症性肠病中，完全内镜愈合与抗TNF治疗停药后较低的复发风险相关。
Complete Endoscopic Healing Is Associated With Lower Relapse Risk After Anti-TNF Withdrawal in Inflammatory Bowel Disease.
作者信息
Mahmoud Remi, Savelkoul Edo H J, Mares Wout, Goetgebuer Rogier, Witteman Ben J M, de Koning Daan B, van Tuyl Sebastiaan A C, Minderhoud Itta, Lutgens Maurice W M D, Akol-Simsek Dilek, van Schaik Fiona D M, Fidder Herma H, Jansen Jeroen M, van Boeckel Petra G A, Mahmmod Nofel, Horjus-Talabur Horje Carmen S, Römkens Tessa E H, Colombel Jean-Frédéric, Hoentjen Frank, Jharap Bindia, Oldenburg Bas
机构信息
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
出版信息
Clin Gastroenterol Hepatol. 2023 Mar;21(3):750-760.e4. doi: 10.1016/j.cgh.2022.08.024. Epub 2022 Aug 31.
BACKGROUND & AIMS: Discontinuation of anti-tumor necrosis factor-α treatment (anti-TNF) (infliximab and adalimumab) in patients with inflammatory bowel disease (IBD) is associated with a high relapse risk that may be influenced by endoscopic activity at the time of stopping. We assessed the relapse rate after anti-TNF withdrawal in patients with endoscopic healing and studied predictors of relapse including the depth of endoscopic healing.
METHODS
This was a multicenter, prospective study in adult patients with Crohn's disease (CD), ulcerative colitis (UC), or IBD-unclassified (IBDU), with ≥6 months of corticosteroid-free clinical remission (confirmed at baseline) and endoscopic healing (Mayo <2/SES-CD <5 without large ulcers), who discontinued anti-TNF between 2018 and 2020 in the Netherlands. We performed Kaplan-Meier and Cox regression analyses to assess the relapse rate and evaluate potential predictors: partial (Mayo 1/SES-CD 3-4) versus complete (Mayo 0/SES-CD 0-2) endoscopic healing, anti-TNF trough levels, and immunomodulator and/or mesalamine use.
RESULTS
Among 81 patients (CD: n = 41, 51%) with a median follow-up of 2.0 years (interquartile range, 1.6-2.1), 40 patients (49%) relapsed. Relapse rates in CD and UC/IBDU patients were comparable. At 12 months, 70% versus 35% of patients with partial versus complete endoscopic healing relapsed, respectively (adjusted hazard rate [aHR], 3.28; 95% confidence interval [CI], 1.43-7.50). Mesalamine use was associated with fewer relapses in UC/IBDU patients (aHR, 0.08; 95% CI, 0.01-0.67). Thirty patients restarted anti-TNF, and clinical remission was regained in 73% at 3 months.
CONCLUSIONS
The relapse risk was high after anti-TNF withdrawal in IBD patients with endoscopic healing, but remission was regained in most cases after anti-TNF reintroduction. Complete endoscopic healing and mesalamine treatment in UC/IBDU patients decreased the risk of relapse.
背景与目的
炎症性肠病（IBD）患者停用抗肿瘤坏死因子-α治疗（抗TNF，英夫利昔单抗和阿达木单抗）与高复发风险相关，而停药时的内镜活动情况可能会影响复发风险。我们评估了内镜愈合的IBD患者停用抗TNF后的复发率，并研究了复发的预测因素，包括内镜愈合的深度。
方法
这是一项针对成年克罗恩病（CD）、溃疡性结肠炎（UC）或未分类炎症性肠病（IBDU）患者的多中心前瞻性研究，这些患者有≥6个月无糖皮质激素的临床缓解（基线时确认）且内镜愈合（梅奥评分<2/简化内镜评分-克罗恩病<5且无大溃疡），于2018年至2020年在荷兰停用抗TNF。我们进行了Kaplan-Meier分析和Cox回归分析，以评估复发率并评估潜在预测因素：部分（梅奥评分1/简化内镜评分-克罗恩病3-4）与完全（梅奥评分0/简化内镜评分-克罗恩病0-2）内镜愈合、抗TNF谷浓度水平，以及免疫调节剂和/或美沙拉嗪的使用情况。
结果
81例患者（CD：n = 41，51%）的中位随访时间为2.0年（四分位间距，1.6 - 2.1年），40例患者（49%）复发。CD患者和UC/IBDU患者的复发率相当。在12个月时，部分内镜愈合与完全内镜愈合的患者复发率分别为70%和35%（调整后风险比[aHR]，3.28；95%置信区间[CI]，1.43 - 7.50）。UC/IBDU患者使用美沙拉嗪与较少的复发相关（aHR，0.08；95% CI，0.01 - 0.67）。30例患者重新开始使用抗TNF，3个月时73%的患者恢复临床缓解。
结论
内镜愈合的IBD患者停用抗TNF后的复发风险很高，但大多数患者重新使用抗TNF后恢复缓解。UC/IBDU患者的完全内镜愈合和美沙拉嗪治疗可降低复发风险。
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