Can anti-TNF treatment be interrupted ?

Monday, 06 February 2012 17:33

Research news

A recent prospective study called Stori, carried out by GETAID (a therapeutic study group devoted to inflammatorydiseases of the digestive tract)

has attempted to answer this question by identifying predictive factors in long-term maintenance of remission of Crohn’s disease (CD) upon arrest of infliximab. 

115 patients with lumen CD, treated using a combination of infliximab and immunosuppressors and who had been in clinical remission without corticoids for over 6 months, were included in this work. 

When immunosuppressive drug treatment was maintained, 45% of patients had a relapse of the disease within the year.  Detailed analysis of these patients revealed factors present at the time of infliximab arrest  that were predictive of relapse.  These included: male gender, tobacco use, persistence of endoscope lesions (even tiny ones), corticotherapy during the preceding year, a C-reactive protein (CRP) count >5 mg/l, hemoglobin levels less than 14.5 g/dl, infliximab dose in the blood equal to or less than 2 mg/l and fecal calprotectin equal to or less than 300 mg/g of stools. 

Given the high number of examinations and tests needed, a simplified model was proposed that excluded both the endoscopic aspect and infliximabemia.  In this model, the group that had more than 4 risk factors showed a relapse rate of 95% within one year, compared to 15% if only two factors were identified.

The good news is that, in those patients who had had relapses, renewed use of infliximab led to remission in 88% of cases after two perfusions (4 months).

References

Study  STORI GETAID, Pr. Edouard Louis (Liège), Chicago DDW 2009