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De-escalation of Therapy in Inflammatory Bowel Disease

  • Inflammatory Bowel Disease (S Hanauer, Section Editor)
  • Published:
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Abstract

Purpose of Review

Currently, inflammatory bowel disease treatment is based on immunomodulators (IM) and/or biologic as this strategy may prevent the development of irreversible damage. Nevertheless, long-term treatment may be associated with non-negligible side effects and with high costs, and therefore the question on whether therapy can be de-escalated is often posed in clinical practice.

Recent Findings

Recent studies have shown a predictable rate of relapse after stop biologic or IM therapy withdrawal. Overall, around 40–50% of patients will eventually relapse over the following year after drug withdrawal, and the rates will increase over time. Stratification of patients and therapeutic drug monitoring could be promising alternatives to guide therapeutic management.

Summary

We reviewed the current evidence on de-escalation strategy and summarised the recent results on discontinuation and dose reduction. Nowadays, de-escalation strategy is still a case-by-case decision in highly selected patients.

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Authors and Affiliations

Authors

Contributions

All authors contributed to the manuscript concept and design. CG reviewed the literature and drafted the manuscript. All authors critically revised the manuscript. All authors have approved the manuscript.

Corresponding author

Correspondence to Jean-Frédéric Colombel.

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Conflict of Interest

Joana Torres reports consulting fees from Takeda and AbbVie.

Jean-Frederic Colombel reports grants from Janssen and Janssen and Takeda; is working as a consultant and/or speaker for AbbVie, Amgen, Boehringer-Ingelheim, Ferring Pharmaceuticals, Genentech, Janssen and Janseen, Medimmune, Merck & Co., Nextbiotix, Novartis Pharmaceuticals Corporation, Otsuka Pharmaceutical Development and Commercialization, Inc., Pfizer, Protagonist, Second Genome, Gilead, Seres Therapeutics, Shire, Takeda, and Theradiag; and holds stock options with Intestinal Biotech Development and Genfit.

Catarina Frias Gomes declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Inflammatory Bowel Disease

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Frias Gomes, C., Colombel, JF. & Torres, J. De-escalation of Therapy in Inflammatory Bowel Disease. Curr Gastroenterol Rep 20, 35 (2018). https://doi.org/10.1007/s11894-018-0643-8

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