R3. 최태웅 / Pf. 김효종 Alimentary Pharmacology & Therapeutics 19 FEB 2016 DOI: 10.1111/apt.13547

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R3. 최태웅 / Pf. 김효종 Alimentary Pharmacology & Therapeutics 19 FEB 2016 DOI: /apt

Background  Tumour necrosis factor (TNF) antagonists, Infliximab(IFX) and adalimumab(ADA) have established induction and maintenance agents in inflammatory bowel disease(ex. Crohn’s disease & ulcerative colitis) therapy  However, the drugs are expensive and remain some concerns over long-term safety  UK regulators mandate reassessment after 12 months’ anti- TNF therapy for IBD, with consideration of treatment withdrawal  Need for more data to establish the relapse rates following treatment cessation

Aim  To establish outcomes following anti-TNF withdrawal using new data from a large UK cohort  Assimilation of all available literature for systematic review and meta-analysis

Methods  A retrospective observational study 166 patients with IBD (146 with Crohn’s disease (CD) and 20 with ulcerative colitis [(UC) and IBD unclassified (IBDU)] withdrawn from anti-TNF for sustained remission  Meta-analysis was undertaken of all published studies incorporating 11 further cohorts totalling 746 patients (624 CD, 122 UC).

Results : Retrospective UK cohort  Out of the 21 centres across the UK, 166 patients, 146 with CD and 20 with UC/IBDU

Crohn’s disease : Montreal classification The Lancet , DOI: ( /S (12) ) Copyright © 2012 Elsevier Ltd Terms and Conditions Terms and Conditions The Lancet Volume 380, Issue 9853, Pages (November 2012)

Results : Retrospective UK cohort

Relapse rate and predictive factors  Relapse rates in CD : 36% by 1 yr, 56% by 2 yrs  Relapse rates in UC/IBDU : 42% by 1 yr, 47% by 2 yrs

Relapse rate and predictive factors  Increased relapse risk in CD was associated with 1) age at diagnosis, 2) white cell count, 3) faecal calprotectin  Neither continued immunomodulators nor endoscopic remission were predictors

Results  In the meta-analysis, estimated 1-year relapse rates were 39% and 35% for CD and UC/IBDU respectively

Conclusions  Approximately one-third of patients with IBD in sustained clinical remission → disease relapse within 12 months of planned drug withdrawal  Unable to predict which patients are most likely to flare