Stopping anti-TNF in CD remitters: pros and cons

Background: There is no cure for Crohn’s disease. Available treatments and treatment strategies, particularly anti-TNF, allow to heal intestinal lesions and maintain steroid-free remission in a subset of patients. Having in mind the remitting/relapsing nature of the disease, patients and health care...

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Autor principal:	Edouard Louis
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/9c7c589f733a4b9e9e8123a4e50722c4
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spelling	oai:doaj.org-article:9c7c589f733a4b9e9e8123a4e50722c42021-12-02T12:40:23ZStopping anti-TNF in CD remitters: pros and cons2296-94032296-936510.1159/000520942https://doaj.org/article/9c7c589f733a4b9e9e8123a4e50722c42021-11-01T00:00:00Zhttps://www.karger.com/Article/FullText/520942https://doaj.org/toc/2296-9403https://doaj.org/toc/2296-9365Background: There is no cure for Crohn’s disease. Available treatments and treatment strategies, particularly anti-TNF, allow to heal intestinal lesions and maintain steroid-free remission in a subset of patients. Having in mind the remitting/relapsing nature of the disease, patients and health care providers often ask themselves whether the treatment could be withdrawn. Several studies have demonstrated a risk of relapse of CD after anti-TNF withdrawal, which varies from 20 to 50% at one year and from 50 to 80% beyond 5 years. These numbers clearly highlight that stopping therapy should not be a systematically proposed strategy in those remitting patients. Summary: Nobody would argue for anti-TNF withdrawal in patients with a high risk of short term relapse. Nevertheless, they also indicate that a minority of patients may not relapse over mid-term and that those who have relapsed may have benefited from a drug-free period before being again treated for a new cycle of treatment. The most relevant question is thus whether in those patients with a low to medium risk of disease relapse, treatment withdrawal could be contemplated. In this specific setting, there may be pros and cons for anti-TNF withdrawal. Amongst the pros are the potential side effects and toxicity of anti-TNF, the risk of loss of response over time, the patient preference allowing the patient to regain control of one’s health and investing in it, also improving adherence, the absence of negative impact on disease evolution of a transient anti-TNF withdrawal and finally the cost. Key messages: Although anti-TNF withdrawal in patients with sustained clinical remission is associated with a high risk of relapse, this risk seems to be much lower in a subgroup of patients, particularly in endoscopic and biologic remission. Stopping anti-TNF in this subgroup of patients may be associated with a favorable benefit/risk ratio.Edouard LouisKarger PublishersarticleDiseases of the digestive system. GastroenterologyRC799-869ENInflammatory Intestinal Diseases (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 Edouard Louis Stopping anti-TNF in CD remitters: pros and cons
description	Background: There is no cure for Crohn’s disease. Available treatments and treatment strategies, particularly anti-TNF, allow to heal intestinal lesions and maintain steroid-free remission in a subset of patients. Having in mind the remitting/relapsing nature of the disease, patients and health care providers often ask themselves whether the treatment could be withdrawn. Several studies have demonstrated a risk of relapse of CD after anti-TNF withdrawal, which varies from 20 to 50% at one year and from 50 to 80% beyond 5 years. These numbers clearly highlight that stopping therapy should not be a systematically proposed strategy in those remitting patients. Summary: Nobody would argue for anti-TNF withdrawal in patients with a high risk of short term relapse. Nevertheless, they also indicate that a minority of patients may not relapse over mid-term and that those who have relapsed may have benefited from a drug-free period before being again treated for a new cycle of treatment. The most relevant question is thus whether in those patients with a low to medium risk of disease relapse, treatment withdrawal could be contemplated. In this specific setting, there may be pros and cons for anti-TNF withdrawal. Amongst the pros are the potential side effects and toxicity of anti-TNF, the risk of loss of response over time, the patient preference allowing the patient to regain control of one’s health and investing in it, also improving adherence, the absence of negative impact on disease evolution of a transient anti-TNF withdrawal and finally the cost. Key messages: Although anti-TNF withdrawal in patients with sustained clinical remission is associated with a high risk of relapse, this risk seems to be much lower in a subgroup of patients, particularly in endoscopic and biologic remission. Stopping anti-TNF in this subgroup of patients may be associated with a favorable benefit/risk ratio.
format	article
author	Edouard Louis
author_facet	Edouard Louis
author_sort	Edouard Louis
title	Stopping anti-TNF in CD remitters: pros and cons
title_short	Stopping anti-TNF in CD remitters: pros and cons
title_full	Stopping anti-TNF in CD remitters: pros and cons
title_fullStr	Stopping anti-TNF in CD remitters: pros and cons
title_full_unstemmed	Stopping anti-TNF in CD remitters: pros and cons
title_sort	stopping anti-tnf in cd remitters: pros and cons
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/9c7c589f733a4b9e9e8123a4e50722c4
work_keys_str_mv	AT edouardlouis stoppingantitnfincdremittersprosandcons
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Stopping anti-TNF in CD remitters: pros and cons

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