Remission maintained by monotherapy after biological + immunosuppressive combination for Crohn's disease in clinical practice
| Autor: | Marina Millán-Lorenzo, M Rojas-Feria, Manuel Romero-Gómez, Manuel Castro-Fernandez, Pedro Guerrero-Jiménez, Javier Ampuero |
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| Rok vydání: | 2015 |
| Předmět: |
Crohn's disease
medicine.medical_specialty Younger age Hepatology Combination therapy business.industry Gastroenterology Disease Odds ratio medicine.disease Inflammatory bowel disease Confidence interval Clinical Practice 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Internal medicine medicine 030211 gastroenterology & hepatology business |
| Zdroj: | Journal of Gastroenterology and Hepatology. 31:112-118 |
| ISSN: | 0815-9319 |
| DOI: | 10.1111/jgh.13039 |
| Popis: | 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 Treatment continued for a further year with one or the other of the combination drugs withdrawn.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) 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 = .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. |
| Databáze: | OpenAIRE |
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