Treatment Withdrawal in Inflammatory Bowel Disease For Remission Maintenance

Abstract

Abstract: Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), requires long-term pharmacological maintenance of remission. Developing de-escalation strategies during remission is crucial for reducing side effects and alleviating economic burdens, though the risks and benefits of discontinuation remain controversial. 5-aminosalicylic acid (5-ASA) can be reduced in some UC patients during remission, but carries a high risk of relapse upon discontinuation. Immunomodulators such as azathioprine present safety concerns with prolonged use, yet safe discontinuation can be achieved through monitoring systems. Biologics show high relapse rates after discontinuation in remission, especially in patients without deep remission. De-escalation in combination therapy requires comprehensive assessment. Post-discontinuation relapse monitoring is critical, with endoscopy and biomarkers such as C-reactive protein (CRP) and fecal calprotectin (FCP) serving as effective predictive tools. This review summarizes recent studies on drug de-escalation in IBD remission, providing guidance for clinical practice and fostering shared decision-making between patients and physicians.

Key words: Inflammatory bowel disease, Exit strategy, Remission, Relapse monitoring

CLC Number:

R574

Gu Yubei, Hong Yu. Treatment Withdrawal in Inflammatory Bowel Disease For Remission Maintenance[J]. Journal of Internal Medicine Concepts & Practice.

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