De-escalation of Therapy in Inflammatory Bowel Disease

Catarina Frias Gomes, Jean Frédéric Colombel, Joana Torres

Research output: Contribution to journalReview articlepeer-review

8 Scopus citations


Purpose of Review: Currently, inflammatory bowel disease treatment is based on immunomodulators (IM) and/or biologic as this strategy may prevent the development of irreversible damage. Nevertheless, long-term treatment may be associated with non-negligible side effects and with high costs, and therefore the question on whether therapy can be de-escalated is often posed in clinical practice. Recent Findings: Recent studies have shown a predictable rate of relapse after stop biologic or IM therapy withdrawal. Overall, around 40–50% of patients will eventually relapse over the following year after drug withdrawal, and the rates will increase over time. Stratification of patients and therapeutic drug monitoring could be promising alternatives to guide therapeutic management. Summary: We reviewed the current evidence on de-escalation strategy and summarised the recent results on discontinuation and dose reduction. Nowadays, de-escalation strategy is still a case-by-case decision in highly selected patients.

Original languageEnglish
Article number35
JournalCurrent Gastroenterology Reports
Issue number8
StatePublished - 1 Aug 2018


  • Anti-TNF
  • Dose reduction
  • Immunomodulators
  • Relapse
  • Therapeutic drug monitoring
  • Withdrawal


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