[en] There are now a growing number of licensed biological therapies for patients with Crohn's disease. However, there can be significant costs associated with long-term maintenance treatment, as well as some concerns about potential side effects. As a result, there has been increasing interest in elective biological treatment discontinuation in selected patients, after a sustained period of remission. Following discontinuation, in cases of relapse, evidence to date has suggested that remission may often be regained by retreatment with the same biological agent. Therefore, a concept has emerged where cycles of biological therapy might be used. If this treatment strategy were to be applied in a subgroup of patients at low-risk of relapse, cycling might allow a substantial number of patients to have a lower, overall therapeutic burden - ensuring decreased exposure to biological therapy but still enabling appropriate disease control. Currently, there remains uncertainty about the benefit-risk balance for using cycles of biological treatment for patients with Crohn's disease. Accordingly, an expert panel was convened by the European Crohn's and Colitis Organisation (ECCO) to review the published literature and agree a series of consensus practice points. The panel aimed to provide evidence-based guidance on multiple aspects of biological treatment discontinuation and cycling, including the risk of relapse after elective treatment discontinuation, predictors of likely relapse or remission, safety, patient preferences and pharmacoeconomic aspects. Crucially, discussions about biological treatment discontinuation and cycling should be individualised, to enable shared decision-making by patients with their clinicians.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Noor, Nurulamin M ; Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University ; Medical Research Council Clinical Trials Unit, University College London, London
Sousa, Paula ; Department of Gastroenterology, Viseu Unit, Tondela-Viseu Hospital Centre
Bettenworth, Dominik; Medical Faculty of the University of Münster, Münster, NRW, Germany.
Gomollon, Fernando ; Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa
Lobaton, Triana; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium. ; Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium.
Bossuyt, Peter ; Imelda GI Clinical Research Centre, Department of Gastroenterology, Imelda
Casanova, Maria Jose; Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de
Ding, Nik S ; Department of Gastroenterology, University of Melbourne, St Vincent's Hospital
Dragoni, Gabriele; Gastroenterology Research Unit, Department of Experimental and Clinical ; IBD Referral Center, Gastroenterology Department, Careggi University Hospital,
Furfaro, Federica; Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Milan,
van Rheenen, Patrick F; University of Groningen, Department of Paediatric Gastroenterology, Hepatology
Chaparro, Maria ; Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de
Gisbert, Javier P ; Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de
Louis, Edouard ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gastroentérologie, hépatologie, onco. digestive ; Department of Hepato-Gastroenterology and Digestive Oncology, Liege University
Papamichael, Konstantinos; Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel
