Background: In patients with inflammatory bowel disease in remission the de – escalating treatment strategy is controversial. Because of safety and economic issues, stopping one therapy in ulcerative colitis (UC) patients in remission might be an option, but there are no recommendation regarding this question. The aim of our study was to assess the risk factors for relapse in UC patients in remission for at least 6 months with combination therapy (anti-TNF and azathioprine – AZA) after AZA discontinuation.
Methods: Between January 2013 and June 2015 we prospective enrolled in a single tertiary center the UC patients who were in clinical remission for at least 6 months with combo therapy (anti-TNF and AZA) and stopped AZA. All patients were evaluated 1 year after AZA withdrawal. Demographics, clinical, endoscopic and therapeutic data were collected.
Results: The study included 56 patients with UC, 32 female and 22 male, with a mean age of 44.6 years (range 18–73 years). All patients were treated with AZA and infliximab (38 patients) or adalimumab (18 patients). 1 year after AZA withdrawal the relapse appeared in 13 patients (23.21%). On multivariate analysis, predictors of relapse were: fecal calprotectin (>50 μg/g, p=0.039), endoscopic Mayo score (>1 vs 0 or 1, p=0.042), and the duration of remission <1 year (p=0.04). There were no statistical differences between the patients who relapsed and those who maintained remission regarding sex, age, smoking habit, extension of the disease, type of anti-TNF.
Conclusions: The azathioprine can be safely withdrawn in patients with combo therapy who are in clinical remission for more than 1 year, have fecal calprotectin <50 μg/g and endoscopic Mayo score 0 or 1.