Ulcerative Colitis Resource Center

Ulcerative Colitis Resource Center

Perspective from Bella Ungar, MD
Disclosures: Kobayashi reports personal fees from Alfresa, Covidien, Eli Lilly, Ferring, Janssen, Kyorin, Mochida, Nippon Kyaku, Pfizer, Takeda, Thermo Scientific, AbbVie, Ajinomoto, Asahi Kasei Medical, Astellas, Celltrion, EA Pharma, Mitsubishi Tanabe, Zeria, Eisai, Gilead Sciences and JIMRO; and grants from AbbVie, EA Pharma, Otsuka, Zeria, Kyorin, Mochida, Thermo Fisher Scientific, Alfresa, Nippon Kyaku and Asahi Kasei Medical.
April 23, 2021
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Infliximab discontinuation links to relapse in patients with ulcerative colitis

Perspective from Bella Ungar, MD
Disclosures: Kobayashi reports personal fees from Alfresa, Covidien, Eli Lilly, Ferring, Janssen, Kyorin, Mochida, Nippon Kyaku, Pfizer, Takeda, Thermo Scientific, AbbVie, Ajinomoto, Asahi Kasei Medical, Astellas, Celltrion, EA Pharma, Mitsubishi Tanabe, Zeria, Eisai, Gilead Sciences and JIMRO; and grants from AbbVie, EA Pharma, Otsuka, Zeria, Kyorin, Mochida, Thermo Fisher Scientific, Alfresa, Nippon Kyaku and Asahi Kasei Medical.
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Discontinued long-term use of infliximab correlated with lower rates of maintained remission in patients with ulcerative colitis, according to research published in The Lancet Gastroenterology and Hepatology.

“Infliximab is an anti-tumor necrosis factor antibody and is one of the most widely used therapies in patients who are corticosteroid-refractory. Maintenance administration every 8-weeks is the standard protocol because of the frequent development of antibodies to infliximab on episodic treatment,” Taku Kobayashi, MD, Center for Advanced IBD Research and Treatment at Kitasato University Kitasato Institute Hospital in Tokyo, Japan, and colleagues wrote. “However, as the number of patients receiving maintenance treatment with infliximab is increasing, questions have arisen regarding whether infliximab could be discontinued in some patients.”

Patients with ulcerative colitis who maintained remission at 48-weeks:

In a multicenter, open-label trial, researchers investigated the outcomes of discontinued infliximab use in patients with UC in remission. They randomly assigned patients 1:1 to either continue infliximab use (n = 46) or discontinue infliximab use (n = 46) and compared remission rates.

At 48 weeks, 80.4% (95% CI, 66.1-90.6) of patients in the infliximab-continued group and 54.3% (95% CI, 39-69.1) of patients in the infliximab-discontinued group were in remission. The between-group remission rate difference was 26.1% (95% CI, 7.7-44.5). Among relapsed patients in the infliximab-discontinued group, 57% received retreatment with infliximab and 66.7% of those patients (95% CI, 34.9-90.1) achieved remission at 8-weeks. Investigators reported one or more adverse event in 17% of patients in the infliximab-continued group and 13% of patients in the infliximab-discontinued group (between-group difference: 3.9%; 95% CI, 10.3-18.1).

“Discontinuing infliximab resulted in significantly more relapse at 1-year than did continuing treatment,” Kobayashi and colleagues concluded. “Remaining subtle inflammation, as estimated based on C-reactive protein and histological inflammation (ie, the Nancy index) might be predictive for future relapse.”