DOP032 Crohn’s disease patients’ perspectives towards de-escalating immunosuppressive therapy: a comparative French and American survey

Siegel, Corey A.; Thompson, Kimberly D.; Walls, Danielle; Gollins, Jan; Buisson, Anne; Olympie, Alain; Beaugerie, Laurent; Colombel, J F; Louis, Édouard

doi:10.1093/ecco-jcc/jjx180.069

Cited by 5 publications

(8 citation statements)

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“…46,49,57,85 CLINICIAN AND PATIENT PERSPECTIVES TO DE-ESCALATION When considering de-escalation, the views of both the clinicians and the patients must be taken into account. Two surveys published in 2017 86 and 2018 87 are particularly illuminating with regard to this aspect of management. The first study, from the BIOCYCLE group, 86 reported that gastroenterologists were significantly more likely to stop immunomodulator use (75% in Europe and 61% in the USA; p=0.05) than biological therapy (23% in Europe and 29% in the USA) for patients in with Crohn's disease who are in remission.…”

Section: Strategy Three: Early Detection and Treatment Of Relapsementioning

confidence: 99%

De-escalation of immunomodulator and biological therapy in inflammatory bowel disease

Chapman

Gomes

Louis

et al. 2020

The Lancet Gastroenterology & Hepatology

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Treatment strategies for inflammatory bowel disease (IBD) focus on the induction and longterm maintenance of deep remission to avoid complications of active disease and improve longterm outcomes. Medical therapies for IBD, notably the increasingly widespread use of biological therapy, are often effective at controlling disease, but these drugs are associated with substantial adverse events, which together with other factors-including increasing treatment costs and patient preferences-leads to concerns regarding indefinite use of medical therapy. Consequently, the need to consider the safety and feasibility of drug de-escalation once IBD remission has been achieved is clear. Here, we review the current evidence surrounding deescalation of immunomodulator and biological therapy in Crohn's disease and ulcerative colitis. We discuss strategies for de-escalation, including the selection of patients who are appropriate for treatment de-escalation and the use of proactive drug monitoring, and review the evidence on subsequent optimal follow-up. We conclude by proposing an algorithm to guide de-escalation decisions, and highlight future perspectives, including the potential effect of emerging medication and personalised medicine for these diseases.

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Section: Strategy Three: Early Detection and Treatment Of Relapsementioning

confidence: 99%

De-escalation of immunomodulator and biological therapy in inflammatory bowel disease

Chapman

Gomes

Louis

et al. 2020

The Lancet Gastroenterology & Hepatology

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“…These risks are too high to propose a treatment withdrawal in all patients reaching sustained steroidfree remission in IBD. This assertion is reinforced by patients' survey highlighting the fact that among them, the majority would only accept a maximum risk of relapse of 25% (11). According to this, we should try to identify a subpopulation with a risk of relapse lower than 25%.…”

Section: The Risk Of Relapse After Treatment Withdrawal In Ibdmentioning

confidence: 99%

“…In a dedicated patients' survey, it was shown that the risk of severe infection or lymphoma that the patient would accept to be in remission would vary very much but would be usually higher than the one accepted by their doctors (31). More specifically, concerning treatment withdrawal, it was shown that the patients would usually prefer to stop immunomodulator than biologic treatments and that the main reason for stopping therapy would be the fear of side effects and particularly cancer (11). As far as the risk of relapse that the patients would accept to be able to stop one of their treatment, the majority would accept up to 25% risk of relapse and up to 5% time with active disease to be able to stop one of their treatments (biologic or immunomodulator) (11).…”

Section: Patients' Preferences and Prioritiesmentioning

confidence: 99%

“…More specifically, concerning treatment withdrawal, it was shown that the patients would usually prefer to stop immunomodulator than biologic treatments and that the main reason for stopping therapy would be the fear of side effects and particularly cancer (11). As far as the risk of relapse that the patients would accept to be able to stop one of their treatment, the majority would accept up to 25% risk of relapse and up to 5% time with active disease to be able to stop one of their treatments (biologic or immunomodulator) (11). These numbers may serve as landmarks when considering treatment withdrawal.…”

Section: Patients' Preferences and Prioritiesmentioning

confidence: 99%

“…These numbers may serve as landmarks when considering treatment withdrawal. However, some patients would not accept any risk of relapse, while others would be ready to accept very high risk to decrease their therapy (11). These questions should be specifically asked to the patients before considering treatment withdrawal.…”

Section: Patients' Preferences and Prioritiesmentioning

confidence: 99%

See 2 more Smart Citations

Tailoring Biologic or Immunomodulator Treatment Withdrawal in Inflammatory Bowel Disease

Louis

2020

Front. Med.

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There is currently no cure for inflammatory bowel disease. Most recent treatments and treatment strategies allow for healing intestinal lesions and maintaining steroid-free remission in a subset of patients. These patients and their doctors often ask themselves whether the treatment could be withdrawn. Several studies in both Crohn's disease and ulcerative colitis have demonstrated a risk of relapse, which varies between 20 and 50% at 1 year and between 50 and 80% beyond 5 years. These numbers clearly highlight that stopping therapy should not be a systematically proposed strategy in those remitting patients. Nevertheless, they also indicate that a minority of patients may not relapse over mid-term and that those who have relapsed may have benefited from a drug-free period before being treated again for a new cycle of treatment. In this context, it would be good to optimally select patients who can be candidates for a successful treatment withdrawal. The criteria impacting this decision are as follows: the risk of relapse (linked to factors like mucosal healing and biomarkers), the consequence of a potential relapse, the tolerance and potential side effects of therapy, patients' priorities and preferences, and the costs. Integration of these parameters allows for the proposal of a decisional algorithm that may help the patients and doctors to make an appropriate decision for their individual case.

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De-escalation of Therapy in Inflammatory Bowel Disease

Gomes

Colombel

Torres

2018

Curr Gastroenterol Rep

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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. 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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DOP032 Crohn’s disease patients’ perspectives towards de-escalating immunosuppressive therapy: a comparative French and American survey

Cited by 5 publications

References 0 publications

De-escalation of immunomodulator and biological therapy in inflammatory bowel disease

De-escalation of immunomodulator and biological therapy in inflammatory bowel disease

Tailoring Biologic or Immunomodulator Treatment Withdrawal in Inflammatory Bowel Disease

De-escalation of Therapy in Inflammatory Bowel Disease

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