Medicine de-escalation strategies in inflammatory bowel disease for remission maintenance

doi:10.16138/j.1673-6087.2025.02.01

Abstract

Abstract:

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn disease (CD), requires long-term medication to maintain remission. Developing a medicine de-escalation strategies during remission is crucial for reducing side effects and alleviating economic burdens, but the risks and benefits of medicine discontinuation remain controversial. The dose of 5-aminosalicylic acid (5-ASA) can be reduced in partial UC patients during remission, but the risk of relapse increases after medicine discontinuation. Long-term use of immunomodulators such as azathioprine has safety issues, but safe discontinuation of the medicine can be achieved through a medicine monitoring systems. The relapse rate after discontinuation of biologics agents during remission is high, especially in patients who have not achieved deep remission. The medicine de-escalation strategy for patient receiving combination therapy requires comprehensive assessment. Relapse monitoring after medicine discontinuation is critical, endoscopy and biomarkers such as C-reactive protein (CRP) and fecal calprotectin (FCP) can be used as effective predictive tools. This review summarizes recent studies on medicine de-escalation in IBD remission to provide reference for clinical practice and promote shared decision-making between patients and physicians.

Key words: Inflammatory bowel disease, Medicine de-escalation, Remission period, Recurrence monitoring

CLC Number:

R574

GU Yubei, HONG Yu. Medicine de-escalation strategies in inflammatory bowel disease for remission maintenance[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(02): 101-106.

Figures/Tables 1

References 44

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