Article Text


PTU-054 Outcomes following Investigation and Elective Withdrawal of Anti-TNF Therapy in Crohn’S Disease: a UK Multicentre Study
  1. A J Brooks1,
  2. S Sebastian2,
  3. K Robinson1,
  4. L Warren3,
  5. A Wright1,
  6. A M Marsh1,
  7. H Tsai2,
  8. F Majeed3,
  9. M E McAlindon1,
  10. P J Hamlin3,
  11. A J Lobo1
  1. 1Sheffield Teaching Hospitals, Sheffield
  2. 2Hull & East Yorkshire NHS Trust, Hull
  3. 3Leeds Teaching Hospitals NHS Trust, Leeds, UK


Introduction The impact of stopping anti-TNF for patients in clinical and/or endoscopic remission in routine clinical practise setting is uncertain. We aimed to evaluate clinical outcomes in patients who discontinued anti-TNF electively across 3 units in the Yorkshire & Humber IBD Network, UK.

Methods Crohn’s disease (CD) patients in whom anti-TNF (62 infliximab (IFX), 9 adalimumab (ADA)) was stopped electively following a planned assessment were included. All had been treated for ≥ 12 months and followed-up for ≥ 3 months following cessation of anti-TNF. Investigations at assessment prior to cessation included ≥ 1 of; colonoscopy, colon capsule (CC), small bowel capsule (SBC), magnetic resonance enterography (MRE), barium study (BS), CRP and clinical assessment (CA).

Results Seventy-one patients (44 female; median age at diagnosis 24 years) were included with a median duration of IBD prior to anti-TNF of 24 (0–264) months. Indications were severe active luminal (50/71), fistulating perianal (18/71) and other fistulating disease (3/71). The median treatment duration was 18 months (range 12–78) with 62 (87%) on immunomodulators post anti-TNF withdrawal. Relapse rates within 90,180 and 365 days were 3/71(4.2%), 14/67(21%) and 27/57(47%) respectively. In perianal disease alone, the relapse rate was 6/18 (33%) at 1 year. 25 of those who relapsed were retreated with anti-TNF, with an overall recapture rate of 84%. In those retreated with the same agent as previously withdrawn the response rate was 80%. A further 5 were successfully retreated with ADA when IFX had been withdrawn. Those (6) who had a dose escalation in 6 months prior to withdrawal all relapsed.

Assessment practise changed following NICE guidance in 2010. Prior to this 5/15(33%) stopping anti-TNF had a CA alone. Following NICE guidance 2/56 (3.6%) were assessed only by CA. Investigations to complement routine CA by Harvey Bradshaw Index (HBI), included ≥ 1 of colonoscopy (52), CC (4), MRE (19), SBC (5), BS (2) and CRP (66). HBI ≥ 4 and a CRP of ≥ 5 in the 6 months prior to formal assessment was observed in 26 patients. 14/26 (54%) relapsed following cessation of anti-TNF (positive predictive value of 61%). Further invasive investigations in this group were abnormal in 2 patients.

Conclusion In this UK cohort, elective withdrawal of anti-TNF was associated with a relapse rate of 48% after 12 months, with a high retreatment response rate. Due to NICE guidance, increased invasive assessment occurred, but the role of endoscopy and imaging to evaluate remission prior to withdrawal of anti-TNF needs further evaluation.

Disclosure of Interest A. Brooks: None Declared, S. Sebastian Conflict with: Dr Sebastian has participated in advisory boards and received speakers honoraria, educational and research grants from Abbott and MSD, K. Robinson: None Declared, L. Warren: None Declared, A. Wright: None Declared, A. Marsh: None Declared, H. Tsai Conflict with: Dr Tsai has participated in advisory boards and received speakers honoraria, educational and research grants from Abbott and MSD, F. Majeed: None Declared, M. McAlindon: None Declared, P. Hamlin Conflict with: Dr Hamlin has participated in advisory boards and received support for specialist nurses from Abbott and MSD, A. Lobo:None Declared

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.