The Majority of Patients With Inflammatory Bowel Disease Are Interested in Drug Discontinuation Despite Risks: 803

Introduction: Inflammatory bowel disease (IBD) is a relapsing, remitting chronic autoimmune condition affecting the gastrointestinal tract. Recent advances in immunosuppression have led to high rates of remission, but discontinuation of immunosuppression is associated with a 50% risk of relapse within 2 years. The aim of this study is to determine whether patients would be interested in drug discontinuation despite this risk of relapse. Methods: This is a retrospective study of patients in our IBD clinic in clinical remission for greater than a year with no signs of ongoing inflammation that were counseled on immunosuppression discontinuation and the risks therein. We examined the electronic health record for their age, duration of disease, disease phenotype and severity, duration of therapy, and disease characteristics (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fecal calprotectin, endoscopy) at time of discussion. All patients were counseled by one of two IBD specialists, and were counseled of a 50% risk of flare within 2 years with a 80-90% chance of recapture with the same agent that was discontinued. Decisions about which patients to offer discontinuation were at the discretion of the provider. Patients who self-elected to discontinue drugs were excluded from the study. Results: 43 patients were counseled on drug discontinuation. Average age was 50.1 ± 15.0 years. Patients had an average of 14.5 ± 9.5 years of disease, and 6.1 ± 5.0 years of the therapy that was discussed for discontinuation. 42 patients (98%) wanted to discontinue drugs. 22 discontinued 6-mercaptopurine, 8 patients discontinued methotrexate, 6 patients discontinued azathioprine, 3 patients discontinued adalimumab, and 3 patients discontinued infliximab. At time of discontinuation, patients had a mean ESR of 19.9 ± 13.0 mm/hr, and a mean CRP 0.34 ± 0.56 mg/dL. After a mean 18.8 ± 19.7 months of follow up, all patients were in clinical remission with ESR (19.5 ± 12.7 mm/hr) and CRP (0.42 ± 0.74 mg/dL). Conclusion: Patients with IBD are overwhelmingly interested in drug discontinuation. In carefully selected patients, discontinuation is safe and well tolerated.