Infliximab discontinuation in patients with ulcerative colitis

Abstract

Biologics have a central role in the treatment of moderate-to-severe ulcerative colitis. However, the question of the optimal clinical scenario and timing for therapy discontinuation has become very relevant. Therapy withdrawal would minimise potential infectious and neoplastic adverse events, and save costs and patients' time. 1 Lichtenstein GR Feagan BG Cohen RD et al. Serious infection and mortality in patients with Crohn's disease: more than 5 years of follow-up in the TREAT registry. Am J Gastroenterol. 2012; 107: 1409-1422 Crossref PubMed Scopus (545) Google Scholar , 2 Lemaitre M Kirchgesner J Rudnichi A et al. Association between use of thiopurines or tumor necrosis factor antagonists alone or in combination and risk of lymphoma in patients with inflammatory bowel disease. JAMA. 2017; 318: 1679-1686 Crossref PubMed Scopus (285) Google Scholar Nevertheless, previous research has shown that episodic, intermittent therapy with anti-tumour necrosis factor (anti-TNF) agents increases the risk of immunogenicity and therapy failure. 3 Rutgeerts P Diamond RH Bala M et al. Scheduled maintenance treatment with infliximab is superior to episodic treatment for the healing of mucosal ulceration associated with Crohn's disease. Gastrointest Endosc. 2006; 63: 433-442 Summary Full Text Full Text PDF PubMed Scopus (512) Google Scholar Discontinuation of infliximab in patients with ulcerative colitis in remission (HAYABUSA): a multicentre, open-label, randomised controlled trialMaintenance of remission was significantly more common in patients who continued infliximab than in those who discontinued. Discontinuing infliximab should therefore be discussed with caution, taking both risk of relapse and efficacy of re-treatment into account. Full-Text PDF