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KMID : 1188320230170020181
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Gut and Liver
2023 Volume.17 No. 2 p.181 ~ p.189
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De-escalation of Therapy in Patients with Quiescent Inflammatory Bowel Disease
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Yusuke Miyatani
Taku Kobayashi
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Abstract
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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.
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KEYWORD
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Inflammatory bowel diseases, De-escalation, Withdrawal, Biological therapy, Immunosuppressive agents
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