{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T08:44:47Z","timestamp":1793781887756,"version":"4.6.1"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,6,1]],"date-time":"2015-06-01T00:00:00Z","timestamp":1433116800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007028","name":"Leona M. and Harry B. Helmsley Charitable Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007028","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Sheba MEdical Center"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Low drug levels are associated with emerging loss of response to anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>. However, this may not be the case in patients with long\u2010term remission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To investigate the outcome of anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> discontinuation in patients with long\u2010term remission and incidental undetectable drug levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study examining the duration of relapse\u2010free survival in <jats:styled-content style=\"fixed-case\">IBD<\/jats:styled-content> patients in remission who discontinued infliximab or adalimumab having undetectable drug levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty eight patients who discontinued anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> while in remission and had available drug levels were identified in two centres in France and Israel (infliximab\u2010treated 35, adalimumab\u201013, Crohn's disease 30, ulcerative colitis 18, mean treatment duration of 22.7\u00a0\u00b1\u00a012.4\u00a0months). Endoscopy\/<jats:styled-content style=\"fixed-case\">MRE<\/jats:styled-content> before stopping showed absence of active inflammation in 40\/42 (95%) of evaluated patients, while inflammatory biomarkers (<jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> and\/or Calprotectin) were completely normal in only 31\/48 (65%) of patients. During 12\u00a0months median follow\u2010up, relapse occurred in 16\/20 (80%) of patients who stopped anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> while having measurable drug levels compared with 9\/28 (32%) of patients who had undetectable drug levels (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>: 8.4, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 2.2\u201332, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.002). Relapse\u2010free survival after anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> cessation was significantly longer in patients with absent drug compared to those with detectable drug (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001, log rank test). On multivariate analysis, a patient's decision to stop therapy was weakly associated and abnormal inflammatory biomarkers and detectable drug levels were both strongly and independently associated with a higher risk of relapse after drug discontinuation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Incidental finding of undetectable anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> drug levels in patients with stable long\u2010term deep remission may identify a subset of patients whose clinical remission is no longer dependent on anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.13268","type":"journal-article","created":{"date-parts":[[2015,6,1]],"date-time":"2015-06-01T06:44:11Z","timestamp":1433141051000},"page":"356-364","source":"Crossref","is-referenced-by-count":75,"title":["Undetectable anti\u2010<scp>TNF<\/scp> drug levels in patients with long\u2010term remission predict successful drug withdrawal"],"prefix":"10.1111","volume":"42","author":[{"given":"S.","family":"Ben\u2010Horin","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Sheba Medical Center Tel Hashomer Israel"},{"name":"Sackler School of Medicine Tel\u2010Aviv University Tel Aviv\u2010Yafo Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Chowers","sequence":"additional","affiliation":[{"name":"Rambam Health Care Campus &amp; Bruce Rappaport School of Medicine Technion Institute of Technology Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Ungar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Sheba Medical Center Tel Hashomer Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.","family":"Kopylov","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Sheba Medical Center Tel Hashomer Israel"},{"name":"Sackler School of Medicine Tel\u2010Aviv University Tel Aviv\u2010Yafo Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Loebstein","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine Tel\u2010Aviv University Tel Aviv\u2010Yafo Israel"},{"name":"Institute of Clinical Pharmacology Sheba Medical Center Tel Hashomer Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine Tel\u2010Aviv University Tel Aviv\u2010Yafo Israel"},{"name":"Edmond &amp; 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