After prolonged CD remission, risk of relapse is higher with discontinuation of infliximab

February 17, 2022

2 minute read



Louis E, et al. Summary OP01. Presented at: European Crohn’s and Colitis Organization Congress; February 16-19, 2022 (virtual meeting).

Disclosures: The study was funded by the European Union’s Horizon 2020 research and innovation program under grant number 633168.

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Patients with Crohn’s disease who discontinued infliximab had a significantly higher risk of relapse than those who continued the combination treatment, according to results presented at the Congress of the European Organization for Crohn’s Disease and colitis.

Discontinuation of infliximab, but not discontinuation of the antimetabolite, was associated with a significantly higher relapse rate than continued combination therapy,” Edouard Louis, MARYLAND, PhD, professor and head of gastroenterology and dean of the faculty of medicine at the University of Liège in Belgium, said during the presentation. “Almost all patients who discontinued infliximab achieved rapid remission upon re-initiation, and failure rates were similar across all groups.”

Louis and his colleagues looked at 254 patients with CD at 64 centers in Europe, Australia and the UK who were treated with combination therapy of infliximab and antimetabolite for more than 8 months. All participants had achieved steroid-free remission for more than 6 months. Of these, 205 were randomly assigned to continue combination therapy (n=67), discontinue infliximab (n=71), or discontinue antimetabolite (n=67).

Relapse rates and mean 2-year survival in remission served as primary endpoints; other endpoints included treatment failure, such as complications or lack of remission.

The 2-year relapse rate in patients assigned to continue combination therapy was 14% (95% CI, 4-23), 40% (95% CI, 28-51) in those who discontinued infliximab and 10% (95% CI, 2 -18) in those stopping the antimetabolite. The time spent in remission was 1.91 years, 1.89 years and 1.93 years, respectively.

“Over the 2-year study duration, in patients stopping infliximab, time spent in remission was 6 days lower compared to the combination treatment and 14 days lower compared to patients stopping the anti -metabolite,” Louis told attendees. “Although small, these differences did not meet the pre-specified criteria for non-inferiority.”

According to the results of the study, 39 patients relapsed and 28 were retreated and optimized. One of the two retired patients who continued the combination treatment achieved remission, as did 22 of the 23 patients who stopped infliximab and two of the three who stopped the antimetabolite. Treatment failure was observed in four patients in the combination and infliximab groups and three patients in the antimetabolite group.

Investigators observed no malignancies among the participants, although one patient developed tuberculosis in the antimetabolite group and two patients developed serious infections in the infliximab group. There were 31 serious adverse events in 20 patients: 10 in patients who continued the combination, 8 in those who stopped infliximab and 13 in those who stopped the antimetabolite.

Jack L. Goldstein