Related Experiment Video
Updated: Jan 8, 2026
Evaluating Therapeutic Interventions in the SHIP-deficient Mouse Model of Crohn Disease-like Ileitis and Fibrosis
Published on: October 14, 2025
Therapy de-escalation in paediatric patients with inflammatory bowel disease in remission: Data analysis from the
Sila Cekin1, Christoph Huenseler1, Serdar Cantez2
1Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Insights
Stepping down combination therapy in pediatric inflammatory bowel disease (IBD) is often successful in Crohn's disease (CD) patients. De-escalating to a single TNF-alpha-inhibitor therapy is more advantageous than other approaches.
Area of Science:
- Pediatric gastroenterology
- Immunomodulatory therapy
- Inflammatory bowel disease (IBD) management
Background:
- Standardized criteria for stepping down combination therapy (immunomodulator and TNF-alpha-inhibitors) in pediatric IBD are lacking.
- De-escalation aims to reduce side effect risks while maintaining disease control.
Purpose of the Study:
- To describe de-escalation practices in a large pediatric IBD cohort.
- To identify prognostic factors for successful de-escalation without requiring further therapy adjustments.
Main Methods:
- Analysis of real-world data from the CEDATA-GPGE registry (2004-2023).
- Comparison of patients who did and did not require therapy adjustments post-de-escalation.
- Identification of prognostic factors for successful de-escalation.
Main Results:
- Crohn's disease (CD) patients were more frequently on combination therapy and more successfully de-escalated than ulcerative colitis (UC) or IBD-unclassified patients.
- Successful de-escalation was more likely in UC patients with less severe disease.
- De-escalation to biologic monotherapy was more successful than to immunomodulator monotherapy or cessation of both agents.
Conclusions:
- De-escalation of combination therapy is more likely to be successful in pediatric CD patients.
- De-escalating to TNF-alpha-inhibitor monotherapy is a more advantageous strategy.
Objectives:
There are no standardized criteria about stepping down from combination therapy (immunomodulator and tumor necrosis factor (TNF)-alpha-inhibitors) in children with inflammatory bowel disease (IBD) to reduce risk for side effects. Our aim was to describe how de-escalation has been performed in a large paediatric cohort and to find prognostic factors for therapy de-escalation without the need for therapy adjustments post-de-escalation.
Methods:
Real-world data from CEDATA-GPGE, a German-Austrian registry for paediatric IBD patients, from 2004 to 2023, were analyzed. Patients not requiring therapy adjustments post-de-escalation and patients requiring therapy adjustments after de-escalation were compared, and prognostic factors were identified.
Results:
Two hundred and thirty out of 6248 registered patients received combination therapy for at least 6 months. In 64 patients therapy adjustment was not required after de-escalation. Crohn's disease (CD) patients, younger patients, and patients with positive modified predictors of poor outcome were significantly more often on combination therapy. Regarding de-escalation, CD patients were more often successfully de-escalated than ulcerative colitis (UC) and IBD-unclassified patients. UC patients with a less severe disease manifestation (Paris classification E1 or E2) were de-escalated more successfully than those with more extensive disease (E3 or E4). De-escalation to monotherapy with a biologic led to a more successful de-escalation than de-escalation to immunomodulator monotherapy or stopping both biologic and immunomodulator.
Conclusions:
De-escalation is more likely successful in patients with CD, and de-escalating combination therapy to monotherapy with a TNF-alpha-inhibitor is more advantageous.
Related Concept Videos
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...