Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): Results of a multidisciplinary international expert panel—EPACT II

Mottet, Christian; Vader, John‐Paul; Felley, Christian; Froehlich, Florian; Gonvers, Jean‐Jacques; Juillerat, Pascal; Stockbrügger, Reinhold W.; Angelucci, E.; Seibold, Frank; Michetti, Pierre; Pittet, Valérie

doi:10.1016/j.crohns.2009.03.008

Cited by 24 publications

(11 citation statements)

References 24 publications

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“…A multidisciplinary European expert panel (EPACT-II) convened in 2007 to develop explicit appropriateness criteria [20][21][22][23] regarding CD treatment. During an update meeting in October 2012, the panel evaluated when and under which conditions it was appropriate to consider withdrawal of CD treatment.…”

Section: Introductionmentioning

confidence: 99%

When do we dare to stop biological or immunomodulatory therapy for Crohn's disease? Results of a multidisciplinary European expert panel

Pittet

Froehlich

Maillard

et al. 2013

Journal of Crohn's and Colitis

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Background: Safety and economic issues have increasingly raised concerns about the long term use of immunomodulators or biologics as maintenance therapies for Crohn's disease (CD). Despite emerging evidence suggesting that stopping therapy might be an option for low risk patients, criteria identifying target groups for this strategy are missing, and there is a lack of recommendations regarding this question. Methods: Multidisciplinary European expert panel (EPACT-II Update) rated the appropriateness of stopping therapy in CD patients in remission. We used the RAND/UCLA Appropriateness Method, and included the following variables: presence of clinical and/or endoscopic remission, CRP level, fecal calprotectin level, prior surgery for CD, and duration of remission (1, 2 or 4 years). Results: Before considering withdrawing therapy, the prerequisites of a C-reactive protein (CRP) and fecal calprotectin measurement were rated as "appropriate" by the panellists, whereas a radiological evaluation was considered as being of "uncertain" appropriateness. Ileo-colonoscopy was considered appropriate 1 year after surgery or after 4 years in the absence of prior surgery. Stopping azathioprine, 6-mercaptopurine or methotrexate mono-therapy was judged appropriate after 4 years of clinical remission. Withdrawing anti-TNF mono-therapy was judged appropriate after 2 years in case of clinical and endoscopic remission, and after 4 years of clinical remission. In case of combined therapy, anti-TNF withdrawal, while continuing the immunomodulator, was considered appropriate after two years of clinical remission. Conclusion: A multidisciplinary European expert panel proposed for the first time treatment stopping rules for patients in clinical and/or endoscopic remission, with normal CRP and fecal calprotectin levels.

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Section: Introductionmentioning

confidence: 99%

When do we dare to stop biological or immunomodulatory therapy for Crohn's disease? Results of a multidisciplinary European expert panel

Pittet

Froehlich

Maillard

et al. 2013

Journal of Crohn's and Colitis

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“…These clinical situations lead to several uncertain treatment indications, but probably reflect current trend in the management of perianal and complex fistulas [13,14]. However, the EPACT II panel results [5][6][7][8] show some disagreement with these above-mentioned clinical management strategies and recommend a more conservative approach. Appropriateness criteria will thus need to evolve constantly to keep up with the literature, but can, however, express other characteristics based on experts' votes.…”

Section: Discussionmentioning

confidence: 90%

“…In the event of disagreement (at least one vote falling in the lowest and one in the highest three-point region) between the experts, the corresponding clinical scenarios were considered uncertain [3]. The results of EPACT II have already been published [5][6][7][8] and are available online in a user-friendly manner (www.epact.ch) for use in clinical practice.…”

Section: Patientsmentioning

confidence: 99%

Infliximab for Crohnʼs disease in the Swiss IBD Cohort Study

Juillerat

Pittet

Vader

et al. 2010

European Journal of Gastroenterology & Hepatology

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“…It is category C, but a number of reviews and studies found no increased risk of preterm delivery, spontaneous abortion, or major malformations with the drug, and the authors considered it safe during pregnancy [15][16][17]. An optional treatment for nongonococcal urethritis is ofloxacin [12•], but because it is category C, it is better to use macrolides (discussed below) for this condition during pregnancy.…”

Section: Fluoroquinolonesmentioning

confidence: 99%

Safety of Common Medications for Treating Dermatology Disorders in Pregnant Women

Malka

Ziv

2013

Curr Derm Rep

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Treating the pregnant woman poses challenges to the physician that requires balancing between eliminating or alleviating a condition or disease and ensuring no untoward effects on the mother and fetus. Despite the importance of the task, human studies are limited for obvious reasons, and animal studies do not fully resemble human physiology. Nevertheless, thanks to epidemiology studies and large-scale reviews of case reports on pregnant patients with comorbidities or refractory diseases that necessitate treatment with drugs of uncertain safety, data are accumulating on the safety of medications during pregnancy. This review summarizes the current literature on the safety during pregnancy of medications frequently used for common dermatologic diseases. The goal is to provide physicians with a handy database for when to, and when not to, prescribe those medications.

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Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): Results of a multidisciplinary international expert panel—EPACT II

Abstract: EPACT II recommendations are freely available online (www.epact.ch). The validity of these criteria should now be tested by prospective evaluation.

Cited by 24 publications

References 24 publications

When do we dare to stop biological or immunomodulatory therapy for Crohn's disease? Results of a multidisciplinary European expert panel

When do we dare to stop biological or immunomodulatory therapy for Crohn's disease? Results of a multidisciplinary European expert panel

Infliximab for Crohnʼs disease in the Swiss IBD Cohort Study

Safety of Common Medications for Treating Dermatology Disorders in Pregnant Women

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