Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
Department of Gastroenterology, St James's University Hospital, Leeds, UK.
BMJ Open Gastroenterol. 2024 Feb 10;11(1):e001225. doi: 10.1136/bmjgast-2023-001225.
Inflammatory bowel disease (IBD) treatment was revolutionised with the arrival of biological therapy two decades ago. There are now multiple biologics and increasingly novel small molecules licensed for the treatment of IBD. Treatment guidelines highlight the need for effective control of inflammation and early escalation to advanced therapies to avoid long-term complications. Consequently, a large proportion of patients with IBD receive advanced therapies for a long time. Despite their beneficial risk-benefit profile, these treatments are not without risk of side effects, are costly to healthcare providers and pose a burden to the patient. It is, therefore, paramount to examine in which circumstances a temporary cessation of therapy can be attempted without undue clinical risk. Some patients may benefit from cyclical rather than continuous treatment. This review examines the risk of relapse after discontinuation of advanced therapies, how to identify patients at the lowest risk of relapse and the chance of recapturing response when flaring after discontinuation.
二十年前，生物疗法的出现彻底改变了炎症性肠病（IBD）的治疗方法。目前已有多种生物制剂和越来越多的新型小分子药物获得批准用于治疗 IBD。治疗指南强调需要有效控制炎症，并尽早升级为高级治疗方法，以避免长期并发症。因此，很大一部分 IBD 患者需要长期接受高级治疗。尽管这些治疗方法具有良好的风险效益比，但它们并非没有副作用风险，而且会给医疗保健提供者带来成本负担，并给患者带来负担。因此，至关重要的是要研究在何种情况下可以尝试在不带来过度临床风险的情况下暂时停止治疗。一些患者可能会受益于周期性而不是连续性治疗。这篇综述探讨了停止高级治疗后复发的风险、如何识别复发风险最低的患者，以及在停药后出现复发时重新获得缓解的机会。
