Background: TNF inhibitor is a well-established treatment in moderate to severe ulcerative colitis (UC). Treatment failure occurs in a large proportion of patients. There are few long-term observational real-life studies and the clinical course in the period following discontinuation of TNF treatment, has been little focused.
Methods: We conducted a systematic review of all patient records for the period of 2001–2014. Demographic, clinical and management data were collected. In addition, disease activity, calprotectin level and ongoing use of TNF inhibitor and/or other anti-inflammatory medication at the last follow-up control was especially emphasized. All data were analysed using PASW version 24.
Results: A total of 87 patients started infliximab treatment until the end of 2011. Of these, 61% were men, mean age 41. Seventy-nine percent had extensive colitis (E3). At start of anti-TNF therapy, 75% used concomitant steroids and 25% used immunomodulators (IMM).
1-year evaluation: Complete remission (CR) (calprotectin <100 mg/kg) was achieved in 45% and partial remission (PR) in 14%. At 1 year, 41% of the patients had discontinued infliximab due to treatment failure or severe adverse events.
The last evaluation (up to 14 years of observation; median 6 years): Eleven patients (13%) were in CR and 3 (3%) in PR, 25 (29%) had undergone colectomy, and 27 (31%) had stopped infliximab due to remission. Of these, 10 patients (37%) restarted anti-TNF (4 years observation), all with complete response.
After discontinuation of TNF inhibitor (up to 13 years of observation; median 4 years): Sixty-five percent of the patients were classified as being in CR and 23% in PR at the last evaluation (excluding all post-colectomy patients). Thirty-seven percent of the patients were using IMM and 19% used oral steroids.
Conclusions: Among patients starting infliximab only 13% were in long-term complete remission. Stopping infliximab due to remission was successful in one third. A high proportion of patients were in steroid free complete remission median 4 years after stopping infliximab. Exit strategies after successful remission-induction anti-TNF treatment in UC patients is highly requested.