Half of patients with Crohn’s disease treated with infliximab experience a relapse within the first year after they stop taking the drug, according to a study published in the January issue of Gastroenterology.
Drugs such as infliximab inhibit the inflammatory cytokine tumor necrosis factor (TNF) and are effective in reducing the symptoms of Crohn’s disease. Many patients experience long periods of remission, and would like to eventually stop taking the drug, because of cost, concerns about long-term safety, or pregnancy.
To determine what happens to patients when patients stop taking the drug, Edouard Louis et al. followed 115 adults with Crohn’s disease who were in stable remission after at least 1 year of treatment with infliximab and an antimetabolite.
Within a year after their therapy was discontinued, almost half the patients experienced a relapse in symptoms (see figure).
However, almost all of these patients responded to a single re-treatment infusion of infliximab—none experienced a significant acute or delayed infusion reaction.
Louis et al. identified factors that determined patients’ risk of relapse, such as smoking, blood levels of specific factors and measurements of disease severity. They propose that simple parameters such as these might be used to identify patients with a low risk of relapse, for whom withdrawal of infliximab could be considered.
However, this study did not contain a control group, and only included patients considered to be the best responders to infliximab therapy (in deep remission when the drug was stopped). The authors state that larger, controlled studies to compare de-escalation strategies are needed.
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Louis E, Mary J-Y, Massouille GV, et al. Maintenance of remission among patients with Crohn’s disease on antimetabolite therapy after infliximab therapy is stopped. Gastroenterology 2012;142: 63-70.e5.
Read a related Clinical Gastroenterology and Hepatology article.
Siegel CA, Finlayson SRG, Sands BE, et al. Adverse events do not outweigh benefits of combination therapy for Crohn’s disease in a decision analytic model. Clin Gastroenterol and Hepatol 2012;10:46-51.