{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:46:43Z","timestamp":1761562003172},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2015,12,30]],"date-time":"2015-12-30T00:00:00Z","timestamp":1451433600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim:<\/jats:title><jats:p>The optimal time to withdraw combined biological\u2009+\u2009immunosuppressive therapy in Crohn's disease is debated. Following remission of 6\u2009months with the combined therapy, we assessed the efficacy of monotherapy in maintaining remission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>Crohn's disease patients (<jats:italic>n<\/jats:italic>\u2009=\u200975) were retrospectively selected from clinical records for having achieved remission within 6\u2009months of receiving combined biological\u2009+\u2009immunosuppressive 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 Treatment continued for a further year with one or the other of the combination drugs withdrawn.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) &lt;\u2009150 and endoscopic remission as CDAI\u2009&lt;\u2009150\u2009+\u2009absence of mucosal lesions\u2009+\u2009no signs of active inflammation on ileocolonoscopy. Crohn's disease relapse was defined as CDAI &gt;\u2009250.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Twenty\u2010eight percent (21\/75) patients were relapsers. Withdrawal of biological therapy was more frequent than immunosuppressive (73.3% <jats:italic>vs<\/jats:italic> 26.7%) with no significant differences in relapse rates (30.9% <jats:italic>vs<\/jats:italic> 20%; <jats:italic>P<\/jats:italic>\u2009=\u20090.401). Endoscopic remission was more accurate than clinical remission (relapse rates: 10.5% <jats:italic>vs<\/jats:italic> 33.9%; <jats:italic>P<\/jats:italic>\u2009=\u20090.05). C\u2010reactive\u2010protein was higher in relapsers (19.2\u2009\u00b1\u200923.7\u2009mg\/L <jats:italic>vs<\/jats:italic> 2.5\u2009\u00b1\u20094.7\u2009mg\/L; <jats:italic>P<\/jats:italic>\u2009=\u20090.009). Multivariate analysis indicated C\u2010reactive protein &gt;\u20095\u2009mg\/L (odds ratios [OR]: 30.12; 95% confidence intervals [95% CI]: 5.91\u2013153.38; <jats:italic>P<\/jats:italic>\u2009=\u20090.0001) and younger age at diagnosis (OR: 1.10; 95% CI: 1.01\u20131.19; <jats:italic>P<\/jats:italic>\u2009=\u20090.047) as independent factors predicting relapse. There was a strong trend toward a protective effect of endoscopic remission (OR: 0.17; 95% CI: 0.02\u20131.22; <jats:italic>P<\/jats:italic>\u2009=\u20090.077).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p>A subgroup of Crohn's disease patients treated with combination therapy can be identified (C\u2010reactive protein &lt;\u20095\u2009mg\/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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.13039","type":"journal-article","created":{"date-parts":[[2015,7,15]],"date-time":"2015-07-15T00:17:11Z","timestamp":1436919431000},"page":"112-118","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Remission maintained by monotherapy after biological\u2009+\u2009immunosuppressive combination for Crohn's disease in clinical practice"],"prefix":"10.1111","volume":"31","author":[{"given":"Javier","family":"Ampuero","sequence":"first","affiliation":[{"name":"Unit for the Clinical Management of Digestive Diseases Valme University Hospital  Sevilla Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda","family":"Rojas\u2010Feria","sequence":"additional","affiliation":[{"name":"Unit for the Clinical Management of Digestive Diseases Valme University Hospital  Sevilla Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Castro\u2010Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Unit for the Clinical Management of Digestive Diseases Valme University Hospital  Sevilla Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Mill\u00e1n\u2010Lorenzo","sequence":"additional","affiliation":[{"name":"Unit for the Clinical Management of Digestive Diseases Valme University Hospital  Sevilla Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro","family":"Guerrero-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Unit for the Clinical Management of Digestive Diseases Valme University Hospital  Sevilla Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Romero\u2010G\u00f3mez","sequence":"additional","affiliation":[{"name":"Unit for the Clinical Management of Digestive Diseases Valme University Hospital  Sevilla Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,12,30]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0b013e32836229fb"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2012.10.020"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.10.052"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa020888"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2010.392"},{"key":"e_1_2_5_7_1","first-page":"269","article-title":"Infectious complications of TNF\u2010\u03b1 inhibitor monotherapy versus combination therapy with immunomodulators in inflammatory bowel disease: analysis of the Food and Drug Administration Adverse Event Reporting System","volume":"22","author":"Deepak P","year":"2013","journal-title":"J. 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