{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:55:50Z","timestamp":1792580150757,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T00:00:00Z","timestamp":1689120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The risk of relapse after anti-tumour necrosis factor [TNF] therapy discontinuation in Crohn\u2019s disease patients with perianal fistulas [pCD] is unclear. We aimed to assess this risk.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A systematic literature search was conducted to identify cohort studies on the incidence of relapse following anti-TNF discontinuation in pCD patients. Individual participant data were requested from the original study cohorts. Inclusion criteria were age \u226516 years, pCD as a (co)indication for start of anti-TNF therapy, more than three doses, and remission of luminal and pCD at anti-TNF discontinuation. The primary outcome was the cumulative incidence of CD relapse using Kaplan\u2013Meier estimates. Secondary outcomes included response to re-treatment and risk factors associated with relapse as assessed by Cox regression analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 309 patients from 12 studies in ten countries were included. The median duration of anti-TNF treatment was 14 months [interquartile range 5.8\u201332.5]. Most patients were treated for pCD without active luminal disease [89%], received first-line anti-TNF therapy [87%], and continued immunomodulatory therapy following anti-TNF discontinuation [78%]. The overall cumulative incidence of relapse was 36% (95% confidence interval [CI] 25\u201348%) and 42% [95% CI 32\u201353%] at 1 and 2 years after anti-TNF discontinuation, respectively. Risk factors for relapse included smoking (hazard ratio [HR] 1.5 [1.0, 2.1]) and history of proctitis (HR 1.7 [1.1, 2.5]). The overall re-treatment response rate was 82%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This individual participant data meta-analysis, on predominantly patients with pCD without active luminal disease and first-line anti-TNF therapy, shows that over half of patients remain in remission 2 years after anti-TNF discontinuation. Therefore, anti-TNF discontinuation may be considered in this subgroup.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjad118","type":"journal-article","created":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T18:17:49Z","timestamp":1689185869000},"page":"134-143","source":"Crossref","is-referenced-by-count":7,"title":["Discontinuation of Anti-Tumour Necrosis Factor Therapy in Patients with Perianal Fistulizing Crohn\u2019s Disease: Individual Participant Data Meta-Analysis of 309 Patients from 12 Studies"],"prefix":"10.1093","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0618-3018","authenticated-orcid":false,"given":"Sebastiaan","family":"ten Bokkel Huinink","sequence":"first","affiliation":[{"name":"Erasmus MC, Department of Gastroenterology and Hepatology , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doranne","family":"Thomassen","sequence":"additional","affiliation":[{"name":"Leiden UMC, Department of Biomedical Data Sciences , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewout W","family":"Steyerberg","sequence":"additional","affiliation":[{"name":"Leiden UMC, Department of Biomedical Data Sciences , Leiden , The Netherlands"},{"name":"Erasmus MC, Department of Public Health , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renske W M","family":"Pauwels","sequence":"additional","affiliation":[{"name":"Erasmus MC, Department of Gastroenterology and Hepatology , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria J","family":"Casanova","sequence":"additional","affiliation":[{"name":"Hospital Universitario de La Princesa, Department of Gastroenterology, Instituto de Investigaci\u00f3n Sanitaria Princesa (IIS-IP), Universidad Aut\u00f3noma de Madrid (UAM) and Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD) , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Bouguen","sequence":"additional","affiliation":[{"name":"University Hospital of Pontchaillou, Department of Gastroenterology and Hepatology , Rennes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce W Y","family":"Mak","sequence":"additional","affiliation":[{"name":"Chinese University of Hong Kong, Department of Medicine and Therapeutics , Hong Kong , Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamas","family":"Moln\u00e1r","sequence":"additional","affiliation":[{"name":"University of Szeged, First Department of Medicine , Szeged , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan J","family":"Lobo","sequence":"additional","affiliation":[{"name":"Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Department of Gastroenterology and Hepatology , Sheffield , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob B","family":"Seidelin","sequence":"additional","affiliation":[{"name":"Herlev Hospital, Department of Gastroenterology, University of Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6676-1222","authenticated-orcid":false,"given":"Aurelien","family":"Amiot","sequence":"additional","affiliation":[{"name":"Henri Mondor Hospital, Assistance Publique-H\u00f4pitaux de Paris (APHP), Paris Est Creteil University (UPEC), Department of Gastroenterology , Creteil , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert","family":"D\u2019Haens","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Academic Medical Centre, Department of Gastroenterology and Hepatology , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1262-2806","authenticated-orcid":false,"given":"Pauline","family":"Rivi\u00e8re","sequence":"additional","affiliation":[{"name":"Hospitalier Universitaire, Department of Gastroenterology and Hepatology , Bordeaux , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3320-7094","authenticated-orcid":false,"given":"Luisa","family":"Guidi","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Department of Gastroenterology , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Bor","sequence":"additional","affiliation":[{"name":"University of Szeged, First Department of Medicine , Szeged , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8142-538X","authenticated-orcid":false,"given":"Wei-Chen","family":"Lin","sequence":"additional","affiliation":[{"name":"Mackay Memorial Hospital, Division of Gastroenterology and Hepatology, Department of Internal Medicine , Taipei , Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Peyrin-Biroulet","sequence":"additional","affiliation":[{"name":"University Hospital of Nancy, Department of Hepato-Gastroenterology , Vandoeuvre-les-Nancy , 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