RESUMO
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 Treatment continued for a further year with one or the other of the combination drugs withdrawn.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) < 150 and endoscopic remission as CDAI < 150 + absence of mucosal lesions + no signs of active inflammation on ileocolonoscopy. Crohn's disease relapse was defined as 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.
Assuntos
Azatioprina/administração & dosagem , Doença de Crohn/tratamento farmacológico , Fármacos Gastrointestinais/administração & dosagem , Imunossupressores/administração & dosagem , Quimioterapia de Indução , Infliximab/administração & dosagem , Quimioterapia de Manutenção , Adolescente , Adulto , Fatores Etários , Biomarcadores/sangue , Proteína C-Reativa/análise , Doença de Crohn/diagnóstico , Quimioterapia Combinada , Endoscopia Gastrointestinal , Feminino , Humanos , Masculino , Recidiva , Indução de Remissão , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
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Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Tetania/complicações , Tetania/diagnóstico , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Síndromes de Malabsorção/complicações , Síndromes de Malabsorção/diagnóstico , Hipocalcemia/complicações , Hipocalcemia/diagnóstico , Dor Abdominal/complicações , Dor Abdominal/etiologia , Corticosteroides/uso terapêutico , Trânsito Gastrointestinal/fisiologia , Trânsito Gastrointestinal/efeitos da radiaçãoRESUMO
No disponible
