There is no data about discontinuation of infliximab (IFX) therapy in patients with inflammatory bowel disease (IBD) in Asia. We investigated the long-term clinical outcome and risk factors for clinical recurrence.Methods:
We retrospectively reviewed medical records of IBD patients from 3 university hospitals who responded to IFX induction therapy. Among them, patients who discontinued scheduled IFX therapy during the favorable maintenance period were enrolled. Fistulizing Crohn's disease (CD) was excluded. Demographic, clinical, laboratory and endoscopic characteristics were recorded. Clinical recurrence was defined as an increase of disease activity by Mayo score/CDAI or addition of new drugs including corticosteroids/immunomodulators or abdominal surgery due to aggravation of symptoms/signs.Results:
In total, 21 ulcerative colitis (UC) patients and 10 CD patients were included. Median duration and number of IFX infusion were 216 days (range 42–1466) and 5 (range 2–29) in UC, and 365 days (range 13–1565) and 8 (range 2–27) in CD. Median duration of follow-up after discontinuation was 874 days (range 150–1689) in UC and 1557 days (range 66–2857) in CD. The relapse rates were 44.6% at a median of 425 days in UC, and 35.4% at median of 465 days in CD using Kaplan-Meier analysis. In contrast, stable disease activity was maintained for more than 2 years in 3 UC patients and 5 years in 3 CD patients. In UC, higher number of IFX infusion, longer duration of IFX treatment, and higher serum albumin level were predictors of sustained clinical benefit after IFX discontinuation (P = 0.02, 0.05 and 0.05, respectively).Conclusions:
Approximately 40% of IBD patients who responded to IFX scheduled therapy experienced a recurrence within 15 months after the discontinuation. Nevertheless there was a subset of patients who achieved a long-term remission, and predictive factors affecting the stable disease duration need further investigation.