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Stopping IBD drugs: which and when? |
 Résumé
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Author(s) : Laurent Beaugerie |
Summary : In patients with ulcerative colitis and sustained clinical remission under 5-amino-salicylates (5-ASA), stopping 5-ASA is associated with an increased risk of relapse, even in patients in deep remission (no macroscopic or microscopic inflammation) and for lengths of previous maintenance treatment exceeding 2 to 3 years. Deliberate thiopurine withdrawal should not be considered in patients with inflammatory bowel disease (IBD) and short-term (less than 2 years) drug-induced remission since stopping drug is associated in this context with a high rate of relapse (up to 60% at 1 year). Stopping thiopurines in long-term IBD responders (above 4 years) is associated with a significant and constant risk of relapse, irrespective of the duration of previous thiopurine-induced remission. In Crohn's disease, non-smoker male patients with persistent biological abnormalities are at the highest risk of early relapse. However, given the long-term safety issues of thiopurines (essentially lymphomas), an indefinite treatment cannot be advised, and the time for considering drug withdrawal should be determined in the next future by tailored risk-benefit simulations. In patients with controlled Crohn's disease under combined therapy with infliximab and immunosuppressants (azathioprine or methotrexate), there is increasing evidence towards higher rates of disease activity in patients under monotherapy with infliximab after withdrawal of immunosuppressants. The risk of relapse of Crohn's disease under monotherapy with immunosuppressant after infliximab withdrawal is lower in patients in deep remission at withdrawal. |
Keywords : drug withdrawal, 5-amino-salicylates, thiopurines, anti-TNF |
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