Gut Liver.  2023 Mar;17(2):181-189. 10.5009/gnl220070.

De-escalation of Therapy in Patients with Quiescent Inflammatory Bowel Disease

• Miyatani Y
• Kobayashi T

• KMID: 2540407
• DOI: http://doi.org/10.5009/gnl220070

Abstract

Inflammatory bowel disease is a chronic disease of unknown origin that requires long-term treatment. The optical duration of maintenance treatment once remission has been achieved remains unclear. When discussing a de-escalation strategy, not only the likelihood of relapse but also, the outcome of retreatment for relapse after de-escalation should be considered. Previous evidence has demonstrated controversial results for risk factors for relapse after de-escalation due to the various definitions of remission and relapse. In fact, endoscopic or histologic remission has been suggested as a treatment target; however, it might not always be indicative of a successful drug withdrawal. For better risk stratification of relapse after de-escalation, it may be necessary to evaluate both the current and previous treatments. Following de-escalation, biomarkers should be closely monitored. In addition to the risk of relapse, a comprehensive understanding of the overall outcome, such as the long-term safety, patient quality of life, and impact on healthcare costs, is necessary. Therefore, a shared decision-making with patients on a case-by-case basis is imperative.

Keyword

Inflammatory bowel diseases; De-escalation; Withdrawal; Biological therapy; Immunosuppressive agents