1. R3. 최태웅 / Pf. 김효종 Alimentary Pharmacology & Therapeutics 19 FEB 2016 DOI: 10.1111/apt.13547 http://onlinelibrary.wiley.com/doi/10.1111/apt.13547/full#apt13547-fig-0001 http://onlinelibrary.wiley.com/doi/10.1111/apt.13547/full#apt13547-fig-0001

2. 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

3. 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

4. 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166 patients with IBD (146 with Crohn’s disease (CD) and 20 with ulcerative colitis [(UC) and IBD unclassified (IBDU)] withdrawn from anti-TNF for sustained remission  Meta-analysis was undertaken of all published studies incorporating 11 further cohorts totalling 746 patients (624 CD,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).

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

6. Crohn’s disease : Montreal classification The Lancet 2012 380, 1590-1605DOI: (10.1016/S0140-6736(12)60026-9) Copyright © 2012 Elsevier Ltd Terms and Conditions Terms and Conditions The Lancet Volume 380, Issue 9853, Pages 1590-1605 (November 2012)

7. Results : Retrospective UK cohort

8. 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

10. 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

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

13. 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