Relapse rate following withdrawal of anti-TNF therapy in patients with inflammatory bowel disease: A real-life cohort fr
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ORIGINAL ARTICLE
Relapse rate following withdrawal of anti-TNF therapy in patients with inflammatory bowel disease: A real-life cohort from northern India Pabitra Sahu 1 & Sudheer K. Vuyyuru 1 & Bhaskar Kante 1 & Ashish Agarwal 1 & Raju Sharma 2 & Prasenjit Das 3 & Rajesh Panwar 4 & Saransh Jain 1 & Sawan Bopanna 1 & Govind Makharia 1 & Saurabh Kedia 1 & Vineet Ahuja 1 Received: 7 January 2020 / Accepted: 17 April 2020 # Indian Society of Gastroenterology 2020
Abstract Background The decision to withdraw anti-tumor necrosis factor (anti-TNF) therapy in patients with inflammatory bowel disease (IBD) remains controversial, especially in the developing world, where its long-term use is restrained by side effects and prohibitive cost. Present study evaluated the relapse rate and its predictors following anti-TNF withdrawal in a cohort of IBD patients from northern India. Methods Patients with IBD who received anti-TNF therapy (induction and beyond), and were under follow-up at All India Institute of Medical Sciences, New Delhi, from January 2005 to July 2018 were included. Demographic features, disease characteristics, duration, response to anti-TNF therapy, and relapse rate after its withdrawal were analyzed. Results Among 4600 patients with IBD under follow-up, 90 (1.9%) received anti-TNF therapy, of whom 11 were excluded (8— complete records unavailable; 3—received only single dose). Of 79 patients (mean age—40.1 ± 14.2 years; 53.2% males; 31 [39.2%] ulcerative colitis, 47 [59.5%] Crohn’s disease; median follow-up—24 [12–39] months), 9 (11.4%) were primary nonresponders, 19 (24.1%) had secondary loss of response, and 51 (64.5%) maintained clinical response on anti-TNF. Anti-TNF was withdrawn in 45 (57%) patients (major causes: financial burden—16.5%; tubercular reactivation—12.7%), of whom 33 were in clinical remission. Over a median follow-up of 26 (7.5–45) months, 15 patients (45.5%) relapsed. Most of them responded to antibiotics, steroids, or anti-TNF agents; only 3 required surgery. On Kaplan-Meier analysis, long disease duration prior to therapy was a significant predictor of relapse (hazard ratio [HR] = 1.33, p = 0.034). Conclusion Almost 50% patients with IBD in clinical remission relapse within a year of anti-TNF withdrawal. However, most of these patients have a favorable disease course and respond to medical therapy. Keywords Anti-TNF therapy withdrawal . Biologicals . Biosimilars . Crohn’s disease . Immunomodulator . Inflammatory bowel disease . Relapse . Tuberculosis . Ulcerative colitis
Introduction Inflammatory bowel disease (IBD) is a rapidly emerging disease in the developing world. With an estimated 1.4 million IBD patients, India potentially has among the highest IBD burden in the world [1, 2]. Anti-tumor necrosis factor (antiTNF) α agents, regarded as one of the major treatment options Research done in: Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110 029, India. * Vineet Ahuja [email protected] Extended author information ava
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