Discontinuation of Immunosuppressive Medications in Children with Inflammatory Bowel Disease on Combination Therapy.

We determined the frequency and factors associated with the first clinical relapse after immunomodulator (IM) withdrawal in a cohort of children with inflammatory bowel disease (IBD) on combination therapy (CT). A total of 105 patients [(89 with Crohn disease (CD)] in clinical remission were included [91 (86.7%) were on infliximab (IFX), 53 (50.5%) with methotrexate, and 52 on azathioprine]. The median duration of CT was 2.1 years (IQR 1.3-2.8). Only 11 (10.5%) patients experienced a clinical relapse over a median duration of follow up of 12.0 months (IQR 5.0-19.0) after IM discontinuation. The median baseline pediatric CD activity index in those with CD who relapsed after IM discontinuation was (IQR: 35.0-55.0) versus those who did not relapse (median 35.0, IQR: 20.0-52.5; p = 0.04). In the patients who did not relapse, the median IFX trough level at IM discontinuation was 6.2 μg/mL and 3.8 μg/mL in those who relapsed.