Crispino F, Michielan A, Grova M, Tieppo C, Mazza M, Rogger TM, Armelao F. Exit strategies in inflammatory bowel disease: Looking beyond anti-tumor necrosis factors. World J Clin Cases 2023; 11(12): 2657-2669 [PMID: 37214561 DOI: 10.12998/wjcc.v11.i12.2657]
Corresponding Author of This Article
Andrea Michielan, MD, Doctor, Azienda Provinciale per i Sevizi Sanitari, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Largo Medaglie d’oro 9, Trento 38122, Italy. andrea.michielan@apss.tn.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Federica Crispino, Andrea Michielan, Mauro Grova, Chiara Tieppo, Marta Mazza, Teresa Marzia Rogger, Franco Armelao
Federica Crispino, Andrea Michielan, Chiara Tieppo, Marta Mazza, Teresa Marzia Rogger, Franco Armelao, Azienda Provinciale per i Servizi Sanitari, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
Mauro Grova, Inflammatory Bowel Disease Unit, Department of Medicine, Azienda Ospedaliera Ospedali Riuniti, Villa Sofia-Cervello, Palermo 90146, Italy
Author contributions: Crispino F, Michielan A designed the study; Grova M, Tieppo C, Mazza M, Rogger TM, Armelao F analysed and interpreted data; Crispino F, Grova M, Michielan A drafted the manuscript; Tieppo C, Mazza M, Rogger TM study supervision; Armelao F critically revised the manuscript for important intellectual content; Crispino F, Grova M, Armelao F, Tieppo C, Mazza M, Rogger TM, Michielan A approved the manuscript.
Conflict-of-interest statement: Dr. Michielan has nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andrea Michielan, MD, Doctor, Azienda Provinciale per i Sevizi Sanitari, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Largo Medaglie d’oro 9, Trento 38122, Italy. andrea.michielan@apss.tn.it
Received: January 20, 2023 Peer-review started: January 20, 2023 First decision: February 22, 2023 Revised: March 10, 2023 Accepted: March 29, 2023 Article in press: March 29, 2023 Published online: April 26, 2023
Abstract
The long-term management of patients with inflammatory bowel disease (IBD) is still a matter of debate, and no clear guidelines have been issued. In clinical practice, gastroenterologists often have to deal with patients in prolonged remission after immunomodulatory or immunosuppressive therapies. When planning an exit strategy for drug withdrawal, the risk of disease relapse must be balanced against the risk of drug-related adverse events and healthcare costs. Furthermore, there is still a dearth of data on the withdrawal of novel biologics, such as the anti-α4β7 integrin antibody (vedolizumab) and anti-IL12/23 antibody (ustekinumab), as well as the small molecule tofacitinib. Models for estimating the risk of disease relapse and the efficacy of retreatment should be evaluated according to the patient's age and IBD phenotype. These models should guide clinicians in programming a temporary drug withdrawal after discussing realistic outcomes with the patient. This would shift the paradigm from an exit strategy to a holiday strategy.
Core Tip: Clinicians are still uncertain about whether and when to consider stopping conventional therapies in inflammatory bowel disease (IBD) for fear of disease relapse. Our review aims to shed light on the optimal discontinuation strategies for biologics and the small molecule tofacitinib in IBD.
