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Article: Stopping anti-tumour necrosis factor therapy in patients with perianal Crohn’s disease

TitleStopping anti-tumour necrosis factor therapy in patients with perianal Crohn’s disease
Authors
Keywordsadult
age
Crohn disease
disease classification
drug withdrawal
Issue Date2019
PublisherWiley-Blackwell. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2036
Citation
Alimentary Pharmacology and Therapeutics, 2019, v. 50 n. 11-12, p. 1195-1203 How to Cite?
AbstractBackground: Little is known of the outcome of patients with perianal Crohn's disease after stopping anti-tumour necrosis factor (TNF) therapy. Aim: To evaluate the rate of relapse in perianal Crohn's disease (CD) after stopping anti-TNF therapy. Methods: Consecutive perianal CD patients treated with anti-TNF therapy with subsequent discontinuation were retrieved from prospective inflammatory bowel disease database of institutes in Hong Kong, Shanghai, Taiwan, Malaysia, Thailand and Singapore from 1997 to June 2019. Cumulative probability of perianal CD relapse was estimated using Kaplan-Meier method. Results: After a median follow-up of 89 months (interquartile range [IQR]: 65-173 months), 44 of the 78 perianal CD patients (56.4%) relapsed after stopping anti-TNF, defined as increased fistula drainage or recurrence of previously healed fistula, after stopping anti-TNF therapy. Cumulative probabilities of perianal CD relapse were 50.8%, 72.6% and 78.0% at 12, 36 and 60 months, respectively. Younger age at diagnosis of CD [adjusted hazard ratio (HR): 1.04; 95% CI 1.01-1.09; P = .04] was associated with a higher chance of perianal CD relapse. Among those with perianal CD relapse (n = 44), retreatment with anti-TNF induced remission in 24 of 29 patients (82.8%). Twelve (27.3%) patients required defunctioning surgery and one (2.3%) required proctectomy. Maintenance with thiopurine was not associated with a reduced likelihood of relapse [HR = 1.10; 95% CI: 0.58-2.12; P = .77]. Among the 17 patients who achieved radiological remission of perianal CD, five (35.3%) developed relapse after stopping anti-TNF therapy after a median of 6 months. Conclusions: More than half of the perianal CD patients developed relapse after stopping anti-TNF therapy. Most regained response after resuming anti-TNF. However, more than one-fourth of the perianal CD patients with relapse required defunctioning surgery. Radiological assessment before stopping anti-TNF is crucial in perianal CD.
Persistent Identifierhttp://hdl.handle.net/10722/287283
ISSN
2019 Impact Factor: 7.515
2015 SCImago Journal Rankings: 2.833

 

DC FieldValueLanguage
dc.contributor.authorMak, JWY-
dc.contributor.authorTang, W-
dc.contributor.authorYip, TCF-
dc.contributor.authorRan, ZH-
dc.contributor.authorWei, SC-
dc.contributor.authorAhuja, V-
dc.contributor.authorKumar, S-
dc.contributor.authorLeung, WK-
dc.contributor.authorHilmi, I-
dc.contributor.authorLimsrivilai, J-
dc.contributor.authorAniwan, S-
dc.contributor.authorLam, BCY-
dc.contributor.authorChan, KH-
dc.contributor.authorNg, KM-
dc.contributor.authorLeung, CM-
dc.contributor.authorLi, MKK-
dc.contributor.authorLo, FH-
dc.contributor.authorSze, ASF-
dc.contributor.authorTsang, SWC-
dc.contributor.authorHui, AJ-
dc.contributor.authorHartono, JL-
dc.contributor.authorNg, SC-
dc.date.accessioned2020-09-22T02:58:38Z-
dc.date.available2020-09-22T02:58:38Z-
dc.date.issued2019-
dc.identifier.citationAlimentary Pharmacology and Therapeutics, 2019, v. 50 n. 11-12, p. 1195-1203-
dc.identifier.issn0269-2813-
dc.identifier.urihttp://hdl.handle.net/10722/287283-
dc.description.abstractBackground: Little is known of the outcome of patients with perianal Crohn's disease after stopping anti-tumour necrosis factor (TNF) therapy. Aim: To evaluate the rate of relapse in perianal Crohn's disease (CD) after stopping anti-TNF therapy. Methods: Consecutive perianal CD patients treated with anti-TNF therapy with subsequent discontinuation were retrieved from prospective inflammatory bowel disease database of institutes in Hong Kong, Shanghai, Taiwan, Malaysia, Thailand and Singapore from 1997 to June 2019. Cumulative probability of perianal CD relapse was estimated using Kaplan-Meier method. Results: After a median follow-up of 89 months (interquartile range [IQR]: 65-173 months), 44 of the 78 perianal CD patients (56.4%) relapsed after stopping anti-TNF, defined as increased fistula drainage or recurrence of previously healed fistula, after stopping anti-TNF therapy. Cumulative probabilities of perianal CD relapse were 50.8%, 72.6% and 78.0% at 12, 36 and 60 months, respectively. Younger age at diagnosis of CD [adjusted hazard ratio (HR): 1.04; 95% CI 1.01-1.09; P = .04] was associated with a higher chance of perianal CD relapse. Among those with perianal CD relapse (n = 44), retreatment with anti-TNF induced remission in 24 of 29 patients (82.8%). Twelve (27.3%) patients required defunctioning surgery and one (2.3%) required proctectomy. Maintenance with thiopurine was not associated with a reduced likelihood of relapse [HR = 1.10; 95% CI: 0.58-2.12; P = .77]. Among the 17 patients who achieved radiological remission of perianal CD, five (35.3%) developed relapse after stopping anti-TNF therapy after a median of 6 months. Conclusions: More than half of the perianal CD patients developed relapse after stopping anti-TNF therapy. Most regained response after resuming anti-TNF. However, more than one-fourth of the perianal CD patients with relapse required defunctioning surgery. Radiological assessment before stopping anti-TNF is crucial in perianal CD.-
dc.languageeng-
dc.publisherWiley-Blackwell. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2036-
dc.relation.ispartofAlimentary Pharmacology and Therapeutics-
dc.rightsPreprint This is the pre-peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Postprint This is the peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.-
dc.subjectadult-
dc.subjectage-
dc.subjectCrohn disease-
dc.subjectdisease classification-
dc.subjectdrug withdrawal-
dc.titleStopping anti-tumour necrosis factor therapy in patients with perianal Crohn’s disease-
dc.typeArticle-
dc.identifier.emailLeung, WK: waikleung@hku.hk-
dc.identifier.authorityLeung, WK=rp01479-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/apt.15547-
dc.identifier.pmid31638274-
dc.identifier.scopuseid_2-s2.0-85074744030-
dc.identifier.hkuros314434-
dc.identifier.volume50-
dc.identifier.issue11-12-
dc.identifier.spage1195-
dc.identifier.epage1203-
dc.publisher.placeUnited Kingdom-

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