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Remission maintained by monotherapy after biological + immunosuppressive combination for Crohn's disease in clinical practice
Author(s) -
Ampuero Javier,
RojasFeria María,
CastroFernández Manuel,
MillánLorenzo Marina,
Guerrero-Jiménez Pedro,
RomeroGómez Manuel
Publication year - 2016
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13039
Subject(s) - medicine , crohn's disease , odds ratio , gastroenterology , confidence interval , disease , multivariate analysis , combination therapy , surgery
Background and Aim: The optimal time to withdraw combined biological + immunosuppressive therapy in Crohn's disease is debated. Following remission of 6 months with the combined therapy, we assessed the efficacy of monotherapy in maintaining remission. Methods: Crohn's disease patients ( n = 75) were retrospectively selected from clinical records for having achieved remission within 6 months of receiving combined biological + immunosuppressive therapy. Treatment continued for a further year with one or the other of the combination drugs withdrawn. Clinical remission was defined as Crohn's Disease Activity Index (CDAI) < 150 and endoscopic remission as CDAI < 150 + absence of mucosal lesions + no signs of active inflammation on ileocolonoscopy. Crohn's disease relapse was defined as CDAI > 250. Results: Twenty‐eight percent (21/75) patients were relapsers. Withdrawal of biological therapy was more frequent than immunosuppressive (73.3% vs 26.7%) with no significant differences in relapse rates (30.9% vs 20%; P = 0.401). Endoscopic remission was more accurate than clinical remission (relapse rates: 10.5% vs 33.9%; P = 0.05). C‐reactive‐protein was higher in relapsers (19.2 ± 23.7 mg/L vs 2.5 ± 4.7 mg/L; P = 0.009). Multivariate analysis indicated C‐reactive protein > 5 mg/L (odds ratios [OR]: 30.12; 95% confidence intervals [95% CI]: 5.91–153.38; P = 0.0001) and younger age at diagnosis (OR: 1.10; 95% CI: 1.01–1.19; P = 0.047) as independent factors predicting relapse. There was a strong trend toward a protective effect of endoscopic remission (OR: 0.17; 95% CI: 0.02–1.22; P = 0.077). Conclusion: A subgroup of Crohn's disease patients treated with combination therapy can be identified (C‐reactive protein < 5 mg/L, endoscopic remission, and older age at Crohn's disease diagnosis) who would continue in remission despite cessation of the biological (expensive) component of the combination therapy.