Colon to Rectum
Inflamm Bowel Dis. 2022;28(2):183–91
Anti-tumor necrosis factor-α withdrawal in children with inflammatory bowel disease in endoscopic and histologic remission
Background: The aim of the present study was to investigate outcomes of anti-tumor necrosis factor (TNF)α withdrawal in selected pediatric patients with inflammatory bowel disease who achieved clinical remission and mucosal and histological healing (MH and HH).
Methods: A retrospective analysis was performed on children and adolescents affected by Crohn’s disease (CD) and ulcerative colitis (UC) who were followed up at 2 tertiary referral centers from 2008 through 2018. The main outcome measure was clinical relapse rates after anti-TNFα withdrawal.
Results: 170 patients received scheduled anti-TNFα treatment; 78 patients with CD and 56 patients with UC underwent endoscopic reassessment. The authors found that MH was achieved by 32 patients with CD (41%) and 30 patients with UC (53.6%); 26 patients with CD (33.3%) and 22 patients with UC (39.3%) achieved HH. The anti-TNFα treatment was suspended in 45 patients, 24 affected by CD and 21 by UC, who all achieved concurrently complete MH (Simplified Endoscopic Score for CD, 0; Mayo score, 0, respectively) and HH. All the patients who suspended anti-TNFα shifted to an immunomodulatory agent or mesalazine. In contrast, 17 patients, 8 with CD and 9 with UC, continued anti-TNFα because of growth needs, the persistence of slight endoscopic lesions, and/or microscopic inflammation. 13 out of 24 patients with CD who suspended anti-TNFα experienced disease relapse after a median follow-up time of 29 months, whereas no recurrence was observed among the 9 patients with CD who continued treatment (p = 0.05). Among the patients with UC, there were no significant differences in relapse-free survival among those who discontinued anti-TNFα and those who did not suspend treatment (p = 0.718).
Conclusions: Despite the application of rigid selection criteria, anti-TNFα cessation remains inadvisable in Crohn’s disease. In contrast, in ulcerative colitis the concurrent achievement of mucosal and histological healing may represent promising selection criteria to identify patients in whom treatment withdrawal is feasible.