Maintenance therapy for Crohn's disease: should it be indefinite?
Ibrahim K Onal1, Yavuz Beyazit, Akif Altinbas
1aDepartment of Gastroenterology, Gazi University Medical School bDepartment of Gastroenterology, Numune Education and Research Hospital, Ankara cDepartment of Gastroenterology, Canakkale State Hospital, Canakkale dDepartment of Gastroenterology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.
European Journal of Gastroenterology & Hepatology
|July 17, 2015
Summary
Identifying predictors for Crohn's disease (CD) relapse can help safely stop long-term immunosuppressants. Mucosal healing and biomarkers like fecal calprotectin show promise for guiding therapy withdrawal.
Area of Science:
- Gastroenterology and immunology
- Inflammatory bowel disease research
- Clinical trial methodology
Background:
- Crohn's disease (CD) is a chronic, progressive inflammatory bowel disease.
- Long-term immunosuppressive or biologic therapies are often required but have side effects and high costs.
- Modifying disease course through mucosal healing and symptom resolution is a key treatment goal.
Purpose of the Study:
- To identify predictors for successful withdrawal of maintenance therapy in Crohn's disease patients in stable remission.
- To validate these predictors in various cohort studies.
- To enable safe cessation of immunosuppressant and/or biologic therapy.
Main Methods:
- Review of clinical behavior and long-term progression in Crohn's disease.
- Analysis of individual parameters: mucosal healing, deep remission, fecal calprotectin, and C-reactive protein.
- Validation of predictive parameter combinations in cohort studies.
Main Results:
- Certain parameters and their combinations show promise in predicting low relapse risk.
- Mucosal healing, deep remission, fecal calprotectin, and C-reactive protein are identified as potential predictors.
- Successful prediction of relapse risk may allow for therapy cessation.
Conclusions:
- Identifying patients with low relapse risk is crucial for discontinuing maintenance therapy in Crohn's disease.
- Mucosal healing and specific biomarkers are promising tools for predicting successful withdrawal of immunosuppressive/biologic therapy.
- Further validation in cohort studies is needed to refine predictors for safe therapy cessation.
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