Discontinuing Anti-TNFα Therapy Increases Relapse Risk
Half of patients with perianal fistulising Crohn disease (CD) who discontinued anti-tumor necrosis factor α (anti-TNFα) therapy experienced a relapse within 5 years after treatment cessation, according to the findings of a recent study.
Using data from a prospective database, the researchers estimated the cumulative probabilities of relapse-free survival among 45 patients with perianal fistulizing CD who discontinued anti-TNFα therapy.
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After a median 62 months of follow-up, 24 patients experienced perianal relapse and 19 patients (79%) needed new surgical drainage. The researchers found that the cumulative probabilities of perianal relapse at years 1 and 5 were 24% and 55%, respectively. Perianal relapse was associated with ileal localization at diagnosis, persistence of external fistula opening, second line anti-TNFα use, and prior dose optimization. However, continuing treatment with immunosuppressive agents decreased this risk.
In addition, 42% of patients experienced luminal relapse at year 5. The cumulative probability of global relapse at year 5 was 67%. Retreatment with anti-TNFα allowed for further remission among 23 of the 24 patients (96%).
“The high risk of relapse (perianal and luminal) may suggest a benefit in pursuing biologics over a longer period in patients with perianal fistulas,” the researchers concluded.
Reference:
Legué C, Brochard C, Bessi G, et al. Outcomes of perianal fistulising Crohn’s disease following anti-TNFα treatment discontinuation [published online May 4, 2018]. Inflamm Bowel Dis. https://doi.org/10.1093/ibd/izy008.
