Systematic review with meta‐analysis: the effects of immunomodulator or biological withdrawal from mono‐ or combination therapy in inflammatory bowel disease

Dohos, Dóra; Hanák, Lilla; Szakács, Zsolt; Kiss, Szabolcs; Párniczky, Andrea; Erőss, Bálint; Pázmány, Piroska; Hegyi, Péter; Patrícia, Silvia

doi:10.1111/apt.16182

Cited by 15 publications

(5 citation statements)

References 74 publications

(343 reference statements)

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“…И здесь не более 29% (42). Что же касается частоты достижения безлекарственной ремиссии, то во временном лаге 8-10 лет это всего лишь 5-10% (9,14). И остро стоят вопросы безопасности, как тематика отдельного и большого разговора.…”

Section: современная терапияunclassified

New opportunities in the diagnosis and treatment of inflammatory bowel diseases

Pershko,

Grinevich,

Ivanyuk

2024

ECG

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The study of inflammatory bowel disease is characterized by dynamism and new discoveries. Subtle and new mechanisms of participation of genetic and environmental factors in the pathogenesis of inflammatory bowel diseases have been deciphered, as well as new classes of drugs have appeared that allow influencing many parts of the inflammatory process. However, the paradox of the situation lies in the fact that the more recent advances and discoveries in the field of biology and medicine, the more “gray spots” become in our understanding of the pathogenesis and approaches to the treatment of this category of patients. At the same time, the fundamental problems of IBD, related to reducing the risk of surgical interventions and restoring the quality of life of patients to the population level, are far from being resolved. The article discusses new methodological approaches to the treatment of patients with inflammatory bowel diseases using new classes of cytostatics and granulocyte-macrophage colony-stimulating factors.

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Section: современная терапияunclassified

New opportunities in the diagnosis and treatment of inflammatory bowel diseases

Pershko,

Grinevich,

Ivanyuk

2024

ECG

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“…The discontinuation of immunomodulator monotherapy is evidently associated with an increased risk of relapse. In a systematic review and meta-analysis encompassing ten randomized controlled trials with 587 included patients, Dohos et al [ 46 ] concluded that continued immunomodulator monotherapy should remain the preferred approach among patients with CD, despite concerns about long-term toxicity. However, the withdrawal of immunomodulator monotherapy did not exhibit a significantly higher risk of relapse within 24 months of follow-up in UC (RR = 1.39, 95%CI: 0.85-2.26, respectively).…”

Section: Introductionmentioning

confidence: 99%

“…However, the withdrawal of immunomodulator monotherapy did not exhibit a significantly higher risk of relapse within 24 months of follow-up in UC (RR = 1.39, 95%CI: 0.85-2.26, respectively). Moreover, discontinuing an immunomodulator in combination with biologics did not demonstrate a higher risk of relapse compared to continuing both drugs (RR = 1.30, 95%CI: 0.81-2.08)[ 46 ].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, a comprehensive meta-analysis indicated that combination therapy correlates with reduced immunogenicity[ 50 ]. The potential withdrawal of immunomodulators from the combination regimen might lead to a heightened risk of antidrug antibody formation, although its impact on clinical outcomes might take more than a year to manifest[ 46 ].…”

Section: Introductionmentioning

confidence: 99%

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Discontinuation of therapy in inflammatory bowel disease: Current views

Meštrović,

Kumric,

Bozic

2024

World J Clin Cases

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The timely introduction and adjustment of the appropriate drug in accordance with previously well-defined treatment goals is the foundation of the approach in the treatment of inflammatory bowel disease (IBD). The therapeutic approach is still evolving in terms of the mechanism of action but also in terms of the possibility of maintaining remission. In patients with achieved long-term remission, the question of de-escalation or discontinuation of therapy arises, considering the possible side effects and economic burden of long-term therapy. For each of the drugs used in IBD (5-aminosalycaltes, immunomodulators, biological drugs, small molecules) there is a risk of relapse. Furthermore, studies show that more than 50% of patients who discontinue therapy will relapse. Based on the findings of large studies and meta-analysis, relapse of disease can be expected in about half of the patients after therapy withdrawal, in case of monotherapy with aminosalicylates, immunomodulators or biological therapy. However, longer relapse-free periods are recorded with withdrawal of medication in patients who had previously been on combination therapies immunomodulators and anti-tumor necrosis factor. It needs to be stressed that randomised clinical trials regarding withdrawal from medications are still lacking. Before making a decision on discontinuation of therapy, it is important to distinguish potential candidates and predictive factors for the possibility of disease relapse. Fecal calprotectin level has currently been identified as the strongest predictive factor for relapse. Several other predictive factors have also been identified, such as: High Crohn's disease activity index or Harvey Bradshaw index, younger age (< 40 years), longer disease duration (> 40 years), smoking, young age of disease onset, steroid use 6-12 months before cessation. An important factor in the decision to withdraw medication is the success of re-treatment with the same or other drugs. The decision to discontinue therapy must be based on individual approach, taking into account the severity, extension, and duration of the disease, the possibility of side adverse effects, the risk of relapse, and patient’s preferences.

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“…Because of the forced discontinuation, the intermittent use of biologics is common in Taiwan. After discontinuation of biologics, the major concerns are disease relapse leading to poor outcomes and the requiring of retreatment with biologics 7 . Some studies have investigated the long‐term clinical outcomes after biologics discontinuation and showed that 23–30% of patients with IBD have a relapse within 1 year 8,9 .…”

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confidence: 99%

Suboptimal Outcomes and Retreatment Rate of Patients With Crohn's Disease After Forced Discontinuation of Biologics: A Nationwide Population‐Based Study

Chen

Chuang

Chang

et al. 2023

Clin Pharma and Therapeutics

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Taiwan's National Health Insurance programme forced discontinuation of biologic use in Crohn's disease after a limited treatment duration, regardless of disease activity. This study investigated the retreatment rate and suboptimal outcomes [i.e., Crohn's disease–related surgeries, hospitalisations, emergency room visits and oral steroid flare‐ups] after forced discontinuation. This retrospective cohort study was conducted using data from the National Health Insurance Database. Patients who received ≥40 weeks of biologic treatment followed by a forced discontinuation were included. The time of biologic retreatment and the cumulative incidence of suboptimal outcomes after the forced discontinuation as well as related risk factors were analyzed. 215 patients were included [68% male]. At the beginning of biologic therapy, the mean age [±SD] was 35.7 [±13.5] years, and the disease duration was 4.46 [±3.52] years. The median [interquartile range] biologic treatment duration was 57.86 [50.3–83.3] weeks. Within the first year after forced discontinuation, 67% of patients [n = 144] were retreated with a second course of biologics, and 53% of patients [n = 114] experienced at least one suboptimal outcome. The independent risk factors associated with the occurrence of suboptimal outcomes were Crohn's disease–related emergency room visits and hospitalisations during biologic therapy [hazard ratio: 2.49; 95% CI: 1.59–3.89]. More than two‐thirds of CD patients required biological retreatment within 1 year after a forced discontinuation. The substantial proportion of patients with poor disease outcomes highlights the need to continue the biologic.

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Systematic review with meta‐analysis: the effects of immunomodulator or biological withdrawal from mono‐ or combination therapy in inflammatory bowel disease

Cited by 15 publications

References 74 publications

New opportunities in the diagnosis and treatment of inflammatory bowel diseases

New opportunities in the diagnosis and treatment of inflammatory bowel diseases

Discontinuation of therapy in inflammatory bowel disease: Current views

Suboptimal Outcomes and Retreatment Rate of Patients With Crohn's Disease After Forced Discontinuation of Biologics: A Nationwide Population‐Based Study

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