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Stopping anti‐tumour necrosis factor therapy in patients with perianal Crohn’s disease
Author(s) -
Mak Joyce Wing Yan,
Tang Whitney,
Yip Terry Cheuk Fung,
Ran Zhi Hua,
Wei Shu Chen,
Ahuja Vineet,
Kumar Sudheer,
Leung Wai Keung,
Hilmi Ida,
Limsrivilai Julajak,
Aniwan Satimai,
Lam Belsy C. Y.,
Chan Kam Hon,
Ng Ka Man,
Leung Chi Man,
Li Michael K. K.,
Lo Fu Hang,
Sze Alex Shun Fung,
Tsang Steven Woon Choy,
Hui Aric J.,
Hartono Juanda Leo,
Ng Siew C.
Publication year - 2019
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.15547
Subject(s) - medicine , interquartile range , hazard ratio , crohn's disease , discontinuation , gastroenterology , surgery , thiopurine methyltransferase , risk factor , inflammatory bowel disease , disease , confidence interval
Summary Background 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.