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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

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    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

    Deputy Editor

    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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Long-term Outcomes after the Discontinuation of Anti-Tumor Necrosis Factor-α Therapy in Patients with Inflammatory Bowel Disease under Clinical Remission: A Korean Association for the Study of Intestinal Disease Multicenter Study

Joo Hye Song1 , Eun Ae Kang2 , Soo-Kyung Park3 , Sung Noh Hong1 , You Sun Kim4 , Ki Bae Bang5 , Kyeong Ok Kim6 , Hong Sub Lee7 , Sang-Bum Kang8 , Seung Yong Shin9 , Eun Mi Song10 , Jong Pil Im11 , Chang Hwan Choi9 , and IBD Research Group of the Korean Association for the Study of Intestinal Diseases

1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 2Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 3Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 4Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, 5Department of Internal Medicine, Dankook University College of Medicine, Cheonan, 6Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, 7Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, 8Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, 9Department of Internal Medicine, Chung-Ang University College of Medicine, 10Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, and 11Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

Correspondence to:Sung Noh Hong
ORCID https://orcid.org/0000-0002-4140-3717
E-mail gisnhong@gmail.com
Soo-Kyung Park
ORCID https://orcid.org/0000-0001-8822-9632
E-mail skparkmd@gmail.com

Joo Hye Song and Eun Ae Kang contributed equally to this work as first authors.

Received: July 29, 2020; Revised: December 6, 2020; Accepted: December 9, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut and Liver

Published online March 26, 2021

Copyright © Gut and Liver.

Abstract

Background/Aims: Our study aimed to evaluate the long-term outcomes and risk factors for relapse after anti-tumor necrosis factor (TNF)-α cessation in inflammatory bowel disease (IBD) patients because they are not well established.
Methods: A retrospective multicenter cohort study was conducted involving patients with Crohn’s disease (CD) or ulcerative colitis (UC) from 10 referral hospitals in Korea who discontinued firstline anti-TNF therapy after achieving clinical remission.
Results: A total of 109 IBD patients (71 CD and 38 UC) with a median follow-up duration of 56 months were analyzed. The cumulative relapse rates at 1, 3, and 5 years were 11.3%, 46.7%, and 62.5% for CD patients and 28.9%, 45.3%, and 60.9% for UC patients. Multivariable Cox analysis revealed that discontinuation owing to the clinician’s decision was associated with lower risk of relapse (vs patient’s preference: hazard ratio [HR], 0.13; 95% confidence interval [CI], 0.04 to 0.48; p=0.002) and adalimumab use was associated with higher risk of relapse (vs infliximab: HR, 4.42; 95% CI, 1.24 to 17.74; p=0.022) in CD patients. Mucosal healing was associated with lower risk of relapse (vs nonmucosal healing: HR, 0.12; 95% CI, 0.02 to 0.83; p=0.031) in UC patients. Anti-TNF re-induction was provided to 52 patients, and a response was obtained in 50 patients. However, 25 of them discontinued retreatment owing to a loss of response (n=15), the patient’s preference (n=6), and other factors (n=4).
Conclusions: More than 60% of IBD patients in remission under anti-TNF therapy relapsed within 5 years of treatment cessation. Anti-TNF re-induction was effective. However, half of the patients discontinued anti-TNF therapy, and 50% of these patients discontinued treatment owing to loss of response.

Keywords: Inflammatory bowel diseases, Tumor necrosis factor inhibitors, Withholding treatment, Recurrence


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Gut and Liver

Published online March 26, 2021

Copyright © Gut and Liver.

Long-term Outcomes after the Discontinuation of Anti-Tumor Necrosis Factor-α Therapy in Patients with Inflammatory Bowel Disease under Clinical Remission: A Korean Association for the Study of Intestinal Disease Multicenter Study

Joo Hye Song1 , Eun Ae Kang2 , Soo-Kyung Park3 , Sung Noh Hong1 , You Sun Kim4 , Ki Bae Bang5 , Kyeong Ok Kim6 , Hong Sub Lee7 , Sang-Bum Kang8 , Seung Yong Shin9 , Eun Mi Song10 , Jong Pil Im11 , Chang Hwan Choi9 , and IBD Research Group of the Korean Association for the Study of Intestinal Diseases

1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 2Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 3Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 4Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, 5Department of Internal Medicine, Dankook University College of Medicine, Cheonan, 6Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, 7Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, 8Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, 9Department of Internal Medicine, Chung-Ang University College of Medicine, 10Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, and 11Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

Correspondence to:Sung Noh Hong
ORCID https://orcid.org/0000-0002-4140-3717
E-mail gisnhong@gmail.com
Soo-Kyung Park
ORCID https://orcid.org/0000-0001-8822-9632
E-mail skparkmd@gmail.com

Joo Hye Song and Eun Ae Kang contributed equally to this work as first authors.

Received: July 29, 2020; Revised: December 6, 2020; Accepted: December 9, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims: Our study aimed to evaluate the long-term outcomes and risk factors for relapse after anti-tumor necrosis factor (TNF)-α cessation in inflammatory bowel disease (IBD) patients because they are not well established.
Methods: A retrospective multicenter cohort study was conducted involving patients with Crohn’s disease (CD) or ulcerative colitis (UC) from 10 referral hospitals in Korea who discontinued firstline anti-TNF therapy after achieving clinical remission.
Results: A total of 109 IBD patients (71 CD and 38 UC) with a median follow-up duration of 56 months were analyzed. The cumulative relapse rates at 1, 3, and 5 years were 11.3%, 46.7%, and 62.5% for CD patients and 28.9%, 45.3%, and 60.9% for UC patients. Multivariable Cox analysis revealed that discontinuation owing to the clinician’s decision was associated with lower risk of relapse (vs patient’s preference: hazard ratio [HR], 0.13; 95% confidence interval [CI], 0.04 to 0.48; p=0.002) and adalimumab use was associated with higher risk of relapse (vs infliximab: HR, 4.42; 95% CI, 1.24 to 17.74; p=0.022) in CD patients. Mucosal healing was associated with lower risk of relapse (vs nonmucosal healing: HR, 0.12; 95% CI, 0.02 to 0.83; p=0.031) in UC patients. Anti-TNF re-induction was provided to 52 patients, and a response was obtained in 50 patients. However, 25 of them discontinued retreatment owing to a loss of response (n=15), the patient’s preference (n=6), and other factors (n=4).
Conclusions: More than 60% of IBD patients in remission under anti-TNF therapy relapsed within 5 years of treatment cessation. Anti-TNF re-induction was effective. However, half of the patients discontinued anti-TNF therapy, and 50% of these patients discontinued treatment owing to loss of response.

Keywords: Inflammatory bowel diseases, Tumor necrosis factor inhibitors, Withholding treatment, Recurrence

Gut and Liver

Vol.15 No.3
May, 2021

pISSN 1976-2283
eISSN 2005-1212

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