Background: Discontinuation of anti-TNF maintenance therapy in patients with Crohn's disease (CD) in remission should be considered in order to reduce the potential long term side effects and costs. Several studies have evaluated relapse rate after discontinuation treatment, but data in penetrating CD are scarce.
Methods: Retrospective observational study including patients with penetrating CD in clinical and endoscopic remission who underwent discontinuation of anti-TNF therapy. Clinical, biological and therapeutic variables were analyzed. Clinical relapse was defined as the presence of symptoms and/or fistule activity with the need of retreatment with anti-TNF.
Results: Twenty-six patients were included: 54% men; median age 39 years (IQR 15–71); 18/26 (69.2%) had perianal disease, 4/26 (15.4%) internal penetrating and 4/26 (15.4%) internal penetrating and perianal disease; 54% treated with Adalimumab, 46% Infliximab. Median time with anti-TNF treatment before discontinuation was 61 months (IQR 6–146). All patients were in clinical remission at the time of anti-TNF discontinuation: in 62% of cases treatment was stopped because of sustained remission, in 16% due to adverse effects and in 12% by patient request.
Median time of follow-up was 38 months (IQR 4–95). During follow-up 7/26 patients (27%) had a clinical relapse, with a median time until relapse of 14 months (IQR 3–29); all these patients regained clinical response after reintroducing anti-TNF treatment. Patients who continued maintenance immunosuppressive therapy after stopping anti-TNF treatment had numerically lower relapse rate [2/15 (13%) vs 5/11 (46%), p=0.081]. Time to relapse was significantly prolonged in patients under immunosuppressive therapy (40.9±12.3 vs. 82.2±8.4 months, p=0.04).
Conclusions: A high proportion of patients with penetrating CD in clinical and endoscopic remission, have prolonged remission after discontinuation of anti-TNF therapy. Treatment with immunosuppressant prolongs the duration of remission after anti-TNF discontinuation.