%0 Journal Article
%T De-escalating therapy in inflammatory bowel disease: Results from an observational study in clinical practice.
%A Arenas A
%A Moreta MJ
%A Ordás I
%A Fernández-Clotet A
%A Caballol B
%A Gallego M
%A Vara A
%A Barastegui R
%A Giner A
%A Prieto C
%A Masamunt MC
%A Candia R
%A Ricart E
%J Gastroenterol Hepatol
%V 47
%N 7
%D 2024 Aug-Sep 8
%M 37562767
%F 5.867
%R 10.1016/j.gastrohep.2023.07.005
%X <B>OBJECTIVE: </B>Combination therapy with an immunomodulator (IMM) and an anti-TNF is commonly recommended in Crohn's disease (CD) and ulcerative colitis (UC) patients. However, little is known about relapse rates after therapeutic de-escalation. This study aimed to evaluate the risk of relapse in a cohort of UC and CD patients with long-standing clinical remission after discontinuation of IMM or anti-TNF and to identify predictive factors for relapse.<BR><B>METHODS: </B>This retrospective study included patients with UC or CD on combination therapy and clinical remission for at least 6 months. IMM or anti-TNF was stopped upon physician decision. Primary objective was to evaluate the relapse rates after discontinuation of IMM or anti-TNF and to analyze predictors of relapse.<BR><B>RESULTS: </B>The study included 88 patients, 48 patients (54.5%) discontinued IMM and 40 (45.5%) anti-TNF. During follow-up, relapse rates were 16.7% and 52.5% in the IMM discontinuation group and anti-TNF discontinuation group, respectively (p<0.001). Multivariate analysis showed that anti-TNF discontinuation (HR=3.01; 95% CI=1.22-7.43) and ileal CD location (HR=2.36; 95% CI=1.02-5.47) were predictive factors for relapse while inflammatory CD phenotype was a protective factor (HR=0.32; 95% CI=0.11-0.90). Reintroduction of anti-TNF upon relapse was effective and safe.<BR><B>CONCLUSIONS: </B>Anti-TNF discontinuation led to significantly higher relapse rates compared to IMM discontinuation in UC and CD patients on combination therapy. Anti-TNF discontinuation and ileal CD location were identified as predictive factors for relapse while inflammatory CD phenotype was a protective factor. Retreatment after anti-TNF discontinuation was effective and safe.