Alakh Gulati, MD1, Omeed Alipour, MD1, Ling Shao, MD, PhD1, Bing Zhang, MD, MAS2
1University of Southern California, Los Angeles, CA; 2University of California San Francisco, San Francisco, CA
Clinical remission has traditionally been the therapeutic target in the treatment of inflammatory bowel disease (IBD). However, emerging paradigms suggest deep remission (DR), often defined as clinical remission and mucosal healing with or without additional criteria, as a goal of therapy. Literature suggests longer intervals to relapse after withdrawing anti-TNFα therapy in DR, compared to clinical remission, in patients with IBD. This meta-analysis aims to determine the rates of relapse following anti-TNFa withdrawal in patients with DR.
Using search terms (“inflammatory bowel diseases” OR “IBD” OR “crohn*” OR “ulcerative colitis” OR “UC” OR “colitis”) AND (“mucosal healing” OR “deep remission” OR “complete remission” OR “full remission” OR “endoscopic remission”), 7,514 studies were identified from Pubmed and EMBASE on Oct 1, 2018. Inclusion criteria were adult IBD patients achieving DR with anti-TNFα treatment, defined as clinical remission and mucosal healing, who were followed to assess for relapse, defined as clinical or endoscopic disease activity. Studies with pediatric patients, patients maintained on steroids, and non-English publications were excluded. Publications were reviewed for inclusion independently by two authors; a third served as tie-breaker. Statistics was performed with OpenMetaAnalyst.
Four manuscripts and one abstract with 234 cases at 1-year and 104 cases at 2-years were included. Anti-TNFα agents used were infliximab or adalimumab in all studies. All patients were withdrawn from anti-TNFα after achieving DR, some were continued on salicylate or immunomodulators. Within one year of withdrawal, 28.3% (67/234; I^2=54.64%, P=0.066) of patients demonstrated relapse from DR. Within two years, 47% (49/104; I^2=0%, P=0.721)) relapsed. No predictors of relapse from DR were reported.
Literature describes the 1-year and 2-year relapse rate after anti-TNFα withdrawal from patients who achieved clinical remission to be approximately 40% and 60%, respectively. We found 1-year and 2-year relapse from DR after anti-TNFα withdrawal to be 28.3% and 47%. While the rates of relapse from DR are greatly reduced compared to relapse from clinical remission, nearly half of patients still experience relapse within two years after stopping anti-TNFα. This highlights the need for patient-physician discussion on significant relapse risk prior to stopping anti-TNFα therapy despite achievement of deep remission.
Citation: Alakh Gulati, MD; Omeed Alipour, MD; Ling Shao, MD, PhD; Bing Zhang, MD, MAS. P0472 - RELAPSE RATE FROM DEEP REMISSION AFTER WITHDRAWAL OF ANTI-TNFA IN INFLAMMATORY BOWEL DISEASE: A META-ANALYSIS. Program No. P0472. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.