Combinations of antitumor necrosis factor alpha (TNFα) and immunomodulators may be indicated in high-risk inflammatory bowel disease patients. Our aims were to compare disease course between children that did and did not step down to anti-TNFα monotherapy and to define risk factors for complicated disease course after stepping down.
A retrospective review of the medical records of consecutive children who were treated with combination therapy.
Of 64 children, 32 continued combination therapy while the others stepped down to monotherapy (median duration of 6 months [range 6-10]). Children that stepped down had a trend of lower anti-TNFα levels (median [interquartile range] of 2.4 [1-4.2] µg/mL) compared to those that did not step down (4.5 [2.2-6.23] µg/mL, p = 0.065). Children with Crohn's disease that stepped down had a significantly higher risk for disease exacerbation, hospital admission, and operation (p < 0.025). Univariate analysis revealed that penetrating phenotype, upper gastrointestinal involvement, higher disease activity at diagnosis, and lower anti-TNFα levels under combination therapy were predictors for complicated course after stepping down.
Stepping down to anti-TNFα monotherapy may be related to lower anti-TNFα levels and to a more complicated disease course thereafter. Predictors for a complicated course were identified.