@article{1a0e369618aa4201beecabc589edf81a,
title = "A User's Guide to De-escalating Immunomodulator and Biologic Therapy in Inflammatory Bowel Disease",
abstract = "De-escalation of immunomodulators and biologic agents in inflammatory bowel disease is frequently discussed with patients and must weigh the risk of continued medical therapy with the risk of disease recurrence. Risk factors for disease flare after withdrawal of inflammatory bowel disease medications such as disease activity at de-escalation, disease prognostic features, and prior course of disease have been identified predominately in retrospective studies, allowing for risk stratification of patients. This review evaluates the published literature regarding therapeutic de-escalation and provides a framework for physicians to apply this to clinical practice. Prospective trials are underway and planned, which should provide further insight into this treatment paradigm and better inform patient selection for this strategy.",
keywords = "Cessation, Crohn's Disease, Deescalation, Treatment Discontinuation, Ulcerative Colitis, Withdrawal",
author = "Hirten, {Robert P.} and Lakatos, {Peter L.} and Jonas Halfvarson and Colombel, {Jean Frederic}",
note = "Funding Information: Funding This work was supported by the European Union's Horizon 2020 Research and Innovation program under grant agreement no. 633168-BIOCYCLE (PHC-13-2014). Conflicts of interest The authors disclose the following: Robert P. Hirten has served as a speaker, a consultant, or an advisory board member for Janssen and HealthMode; has received research support from Intralytix and a Career Development Award from the Crohn's and Colitis Foundation. Peter L. Lakatos has been a speaker and/or advisory board member for AbbVie, Arena Pharmaceuticals, Celltrion, Falk Pharma GmbH, Ferring, Genetech, Janssen, Merck, Pharmacosmos, Pfizer, Roche, Shire, and Takeda; and has received unrestricted research grants from AbbVie, MSD, and Pfizer. Jonas Halfvarson has served as a speaker, a consultant or an advisory board member for AbbVie, Celgene, Celltrion, Ferring, Hospira, Janssen, MEDA, Medivir, MSD, Novartis, Olink Proteomics, Pfizer, Prometheus Laboratories, Sandoz, Shire, Takeda, Thermo Fisher, Tillotts Pharma, Vifor Pharma, and UCB and has received grant support from Janssen, MSD, and Takeda. Jean Frederic Colombel has received research grants from AbbVie, Janssen Pharmaceuticals, and Takeda; has received payment for lectures from AbbVie, Amgen, Allergan, Ferring Pharmaceuticals, Shire, and Takeda; has received consulting fees from AbbVie, Amgen, Arena Pharmaceuticals, Boehringer Ingelheim, Celgene Corporation, Celltrion, Eli Lilly, Enterome, Ferring Pharmaceuticals, Genentech, Janssen Pharmaceuticals, Landos, Ipsen, Medimmune, Merck, Novartis, Pfizer, Shire, Takeda, and Tigenix; and holds stock options in Intestinal Biotech Development and Genfit. Funding Information: Funding This work was supported by the European Union{\textquoteright}s Horizon 2020 Research and Innovation program under grant agreement no. 633168-BIOCYCLE (PHC-13-2014). Publisher Copyright: {\textcopyright} 2020 AGA Institute",
year = "2020",
month = may,
doi = "10.1016/j.cgh.2019.12.019",
language = "English",
volume = "18",
pages = "1336--1345",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
publisher = "W.B. Saunders Ltd",
number = "6",
}