Stopping anti-TNF agents in patients with crohn's disease in remission: is it a feasible long-term strategy?

Sorrentino, Dario, Nash, Peter, Viladomiu, Monica, Hontecillas, Raquel and Bassaganya-Riera, Josep (2014) Stopping anti-TNF agents in patients with crohn's disease in remission: is it a feasible long-term strategy?. Inflammatory Bowel Diseases, 20 4: 757-766. doi:10.1097/01.MIB.0000442680.47427.bf


Author Sorrentino, Dario
Nash, Peter
Viladomiu, Monica
Hontecillas, Raquel
Bassaganya-Riera, Josep
Title Stopping anti-TNF agents in patients with crohn's disease in remission: is it a feasible long-term strategy?
Journal name Inflammatory Bowel Diseases   Check publisher's open access policy
ISSN 1078-0998
1536-4844
Publication date 2014-04-01
Year available 2014
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/01.MIB.0000442680.47427.bf
Open Access Status DOI
Volume 20
Issue 4
Start page 757
End page 766
Total pages 10
Place of publication Philadelphia, United States
Publisher Lippincott Williams & Wilkins
Language eng
Subject 2715 Gastroenterology
2723 Immunology and Allergy
Abstract Crohn's disease (CD) is a chronic inflammatory disorder whose incidence is on the rise. Its relentless course often leads to surgery if the disease is left untreated. CD etiology is unknown and as such, it cannot be cured. As it is often the case with such conditions, the next best option to keep the disease under control is to suppress inflammation.1 Today's therapeutic armamentarium for CD includes steroids, antibiotics, immunomodulators (IM) and biologics. The latter, in most countries, only include tumor necrosis factor (TNF) neutralizing agents (infliximab, adalimumab, and certolizumab), by far the most effective agents. As in other chronic diseases, medical treatment must be life long to keep inflammation under control. Stopping therapy, by definition, is expected to cause quick relapse of inflammation. Yet, recent clinical data have partly challenged this basic assumption in the management of CD. Here, we will first review the original data suggesting that medical therapy with anti-TNF agents must be continuous to be effective in the long term. We will then review more recent data that indicate that anti-TNF agents may be stopped in a proportion of patients in remission without a major impact on disease control; the risk factors associated with relapse on stopping therapy and the likelihood of reinducing remission with the same medication in relapsing patients. Next, we will focus on the potential biological and clinical implications of these observations and discuss possible alternative long-term options in CD management.
Keyword Anti-TNF agents
Crohn's disease
Immunomodulators
Long term therapy
Stopping biologics
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2015 Collection
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