Review Article

Optimal Endpoint of Therapy in IBD: An Update on Factors Determining a Successful Drug Withdrawal

Table 5

Risk factors of relapse after drug withdrawal (HR: hazard ratio; RR: relative risk; OR: odds ratio; CI: confidence intervals). Results originate from multivariable analysis, except from [20, 30], where the univariate analysis identified only one risk factor in each group.

AuthorsYearMedicationDiseasePredictive of (while on therapy)Predictive of (after drug withdrawal)
RelapseRisk (when available)Sustained remissionRelapseRisk (when available)Sustained remission

Hawthorne et al. [12] 1992 Azathioprine UCHR (one year older): 0.95; 95% CI: 0.93–0.98Older age
HR: 0.97; 95% CI: 0.93–1.01; Longer duration of remission at entry

Cassinotti et al. [27] 2009 Azathioprine UCConcomitant aminosalicylatesDuration of azathioprine therapy (3–6 months versus >48 months)HR: 2.78; 95% CI: 1.27–6.11
No remission versus remissionHR: 2.35; 95% CI: 1.43–3.85
Disease extent: left sided versus extensive colitisHR: 1.79; 95% CI: 1.06–3.02
Proctosigmoiditis versus extensive colitisHR: 2.02; 95% CI: 1.10–3.72

Bouhnik et al. [16] 1996 Thiopurine CDFemale genderRR: 2.3; 95% CI: 1.0–5.1Male genderRR: 5.2; 95% CI: 2.2–12.0
Age of ≤26 yearsRR: 2.5; 95% CI: 1.3–4.5
Duration of remission (<4 years)RR: 6.6; 95% CI: 2.7–16.2

Lémann et al. [15] 2005 Azathioprine CDCRP ≥ 20 mg/LRR: 16.9; 95% CI: 2.7–104.3
Hemoglobin ≤ 12 g/dLRR: 8.7; 95% CI: 1.6–48.8
Longer time without steroids (≥50 months)RR: 5.2; 95% CI: 1.5–18.1

Treton et al. [18] 2009 Azathioprine CDCRP ≥ 20 mg/LHR: 58.6; 95% CI: 7.5–457
Neutrophil count ≥ 4 × 109/LHR: 3.2; 95% CI: 1.6–6.3
Hemoglobin ≤ 12 g/dLHR: 4.8; 95% CI: 1.7–13.7

Kim et al. [28] 1999 6-Mercaptopurine CDYounger age 1 year increase in age = 2.8% decrease of HR (95% CI: 1.0–4.8%)
Higher mercaptopurine doses 1 mg increase in remission doses = 1.8% increase of HR 1.8% (95% CI: 0.7–2.8%)

Farkas et al. [24]2013InfliximabUCPrevious cycle of infliximab therapy

Domènech et al. [20] 2005 Infliximab CDPartial response in luminal CD after three infusions
Perianal disease in luminal and perianal CD after 1 year treatment

Steenholdt et al. [30]2012InfliximabCDLonger disease duration at first infusion (median: 7 vs. 5 yrs)HR: 1.1; 95% CI: 1.0–1.1

Louis et al. [22]2012InfliximabCDMale genderHR: 3.7; 95% CI: 1.9–7.4
Corticosteroid use in the preceding 6–12 monthsHR: 3.5; 95% CI: 1.1–10.7
Infliximab trough levels ≥ 2 mg/mLHR: 2.5; 95% CI: 1.1–5.4
CDEIS > 0HR: 2.3; 95% CI: 1.1–4.9
Leukocyte count > 6 × 109/LHR: 2.4; 95% CI: 1.2–4.7
Hemoglobin ≤ 145 g/LHR: 6.0; 95% CI: 2.2–16.5
CRP ≥ 5 mg/LHR: 3.2; 95% CI: 1.6–6.4
Fecal calprotectin ≥ 300 μg/gHR: 2.5; 95% CI: 1.1–5.8
Absence of surgical resectionHR: 4.0; 95% CI: 1.4–11.4

Molnár et al. [23]2013Infliximab or adalimumabCDPrevious biological therapyOR: 4.23; 95% CI: 1.39–12.84
Dose-intensification during the 1-year anti-TNF therapyOR: 12.96; 95% CI: 1.39–120.5
Corticosteroid use at the beginning of anti-TNF therapy (in patients not receiving steroids)
Smoking status (in patients not receiving steroids)
Male gender (if patients with dose-intensification are excluded)OR: 2.92; 95% CI: 1.06–8.2