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Relapse rate following withdrawal of anti-TNF therapy in patients with inflammatory bowel disease: A real-life cohort from northern India

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Abstract

Background

The decision to withdraw anti-tumor necrosis factor (anti-TNF) therapy in patients with inflammatory bowel disease (IBD) remains controversial, especially in the developing world, where its long-term use is restrained by side effects and prohibitive cost. Present study evaluated the relapse rate and its predictors following anti-TNF withdrawal in a cohort of IBD patients from northern India.

Methods

Patients with IBD who received anti-TNF therapy (induction and beyond), and were under follow-up at All India Institute of Medical Sciences, New Delhi, from January 2005 to July 2018 were included. Demographic features, disease characteristics, duration, response to anti-TNF therapy, and relapse rate after its withdrawal were analyzed.

Results

Among 4600 patients with IBD under follow-up, 90 (1.9%) received anti-TNF therapy, of whom 11 were excluded (8—complete records unavailable; 3—received only single dose). Of 79 patients (mean age—40.1 ± 14.2 years; 53.2% males; 31 [39.2%] ulcerative colitis, 47 [59.5%] Crohn’s disease; median follow-up—24 [12–39] months), 9 (11.4%) were primary non-responders, 19 (24.1%) had secondary loss of response, and 51 (64.5%) maintained clinical response on anti-TNF. Anti-TNF was withdrawn in 45 (57%) patients (major causes: financial burden—16.5%; tubercular reactivation—12.7%), of whom 33 were in clinical remission. Over a median follow-up of 26 (7.5–45) months, 15 patients (45.5%) relapsed. Most of them responded to antibiotics, steroids, or anti-TNF agents; only 3 required surgery. On Kaplan-Meier analysis, long disease duration prior to therapy was a significant predictor of relapse (hazard ratio [HR] = 1.33, p = 0.034).

Conclusion

Almost 50% patients with IBD in clinical remission relapse within a year of anti-TNF withdrawal. However, most of these patients have a favorable disease course and respond to medical therapy.

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Acknowledgments

This study was part of a project under Indian Council of Medical Research-Centre for Advanced Research in Intestinal diseases.

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Authors and Affiliations

  1. Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 019, India

    Pabitra Sahu, Sudheer K. Vuyyuru, Bhaskar Kante, Ashish Agarwal, Saransh Jain, Sawan Bopanna, Govind Makharia, Saurabh Kedia & Vineet Ahuja

  2. Department of Radiology, All India Institute of Medical Sciences, New Delhi, 110 029, India

    Raju Sharma

  3. Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110 029, India

    Prasenjit Das

  4. Department of GI Surgery, All India Institute of Medical Sciences, New Delhi, 110 029, India

    Rajesh Panwar

Authors
  1. Pabitra Sahu
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Contributions

Conceptualization: Vineet Ahuja, Saurabh Kedia. Methodology: Vineet Ahuja, Saurabh Kedia, Govind Makharia. Formal analysis: Saurabh Kedia, Pabitra Sahu. Funding acquisition: None. Project administration: Vineet Ahuja. Visualization: Vineet Ahuja, Saurabh Kedia. Writing–Pabitra Sahu, Saurabh Kedia, Vineet Ahuja; Writing—review and editing: Vineet Ahuja, Saurabh Kedia, Raju Sharma, Prasenjit Das, Ashish Agarwal, Saransh Jain, Sudheer K Vuyyuru, Bhaskar Kante, Sawan Bopanna. Approval of final manuscript: all authors.

Corresponding author

Correspondence to Vineet Ahuja.

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Conflict of interest

PS, SKV, BK, AA, RS, PD, RP, SJ, SB, GM, SK, and VA declare that they have no conflict of interest.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Research done in: Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110 029, India.

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Sahu, P., Vuyyuru, S.K., Kante, B. et al. Relapse rate following withdrawal of anti-TNF therapy in patients with inflammatory bowel disease: A real-life cohort from northern India. Indian J Gastroenterol 39, 388–397 (2020). https://doi.org/10.1007/s12664-020-01043-w

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  • DOI: https://doi.org/10.1007/s12664-020-01043-w

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