Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
Gut Liver. 2023 Mar 15;17(2):181-189. doi: 10.5009/gnl220070. Epub 2022 Nov 14.
Inflammatory bowel disease is a chronic disease of unknown origin that requires long-term treatment. The optical duration of maintenance treatment once remission has been achieved remains unclear. When discussing a de-escalation strategy, not only the likelihood of relapse but also, the outcome of retreatment for relapse after de-escalation should be considered. Previous evidence has demonstrated controversial results for risk factors for relapse after de-escalation due to the various definitions of remission and relapse. In fact, endoscopic or histologic remission has been suggested as a treatment target; however, it might not always be indicative of a successful drug withdrawal. For better risk stratification of relapse after de-escalation, it may be necessary to evaluate both the current and previous treatments. Following de-escalation, biomarkers should be closely monitored. In addition to the risk of relapse, a comprehensive understanding of the overall outcome, such as the long-term safety, patient quality of life, and impact on healthcare costs, is necessary. Therefore, a shared decision-making with patients on a case-by-case basis is imperative.
炎症性肠病是一种病因不明的慢性疾病，需要长期治疗。达到缓解后维持治疗的光学持续时间尚不清楚。在讨论降级策略时，不仅应考虑降级后复发的可能性，还应考虑降级后复发的再治疗结果。由于缓解和复发的定义不同，先前的证据表明降级后复发的危险因素存在争议结果。事实上，内镜或组织学缓解已被提议作为治疗目标；然而，它并不总是表明药物成功停药。为了更好地对降级后复发进行风险分层，可能有必要评估当前和以前的治疗。降级后应密切监测生物标志物。除了复发的风险外，还需要全面了解整体结果，例如长期安全性、患者生活质量以及对医疗保健成本的影响。因此，需要根据具体情况与患者进行共同决策。
