Withdrawal of immunosuppressant or biologic therapy for patients with quiescent Crohn's disease

Abstract

The effects of withdrawal of immunosuppressant therapy in people with quiescent Crohn's disease are uncertain. Low quality evidence suggests that continuing azathioprine monotherapy may be superior to withdrawal for avoiding clinical relapse, while very low quality evidence suggests that there may be no difference in clinical relapse rates between discontinuing azathioprine from a combination therapy regimen, compared to continuing combination therapy. It is unclear whether withdrawal of azathioprine, initially administered alone or in combination, impacts on the development of CD-related complications, adverse events, serious adverse events or withdrawal due to adverse events. Further high-quality research is needed in this area, particularly double-blind RCTs in which biologic therapy or an immunosuppressant other than azathioprine is withdrawn.

2019 Novel Coronavirus Infection: Gastrointestinal Manifestations

“…Probably, the advocacy of the facilities of "tele-medicine" would be able to untangle a part of this complex sociomedical issue. Thus, with inadequate data of increased risk for IBD subgroup, 42 longer clearance time for certain drugs, such as thiopurine, 44 increased risk of disease flare on stopping IBD medications 45 and poor hospital/clinic backup for chronic cases, 46 it is tricky to ensure best management for active disease. Real-world data on the actual outcome of patients with IBD and COVID-19 infection are lacking.…”

Perspectives From Patients and Gastroenterologists on De-escalating Therapy for Crohn’s Disease

“…There are limited data on the benefits and risks of de-escalating combination therapy to monotherapy for patients with Crohn's disease who are in remission. 5,6,7,8 More prospective data are needed to support the strategy of de-escalation of combination therapy, and a trial called SPARE is currently underway internationally. As data emerge to guide this difficult clinical decision, patient and providers preferences need to be taken into account.…”

Mucosal healing is not associated with better outcome during seven years of follow-up in pediatric patients with Crohn's disease

“…The total number of hospitalizations in the MH and No MH groups did not differ signi cantly (5 vs. 41, P = 0.15) ( Table 2). The time to the rst hospitalization was also similar for the MH group (24 months [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]) and the No MH group (21 months ), p > 0.99 (Table 2), also shown in the survival data curve (Fig. 1).…”