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Review
. 2024 Feb 10;11(1):e001225.
doi: 10.1136/bmjgast-2023-001225.

Biological therapy for inflammatory bowel disease: cyclical rather than lifelong treatment?

Christian Philipp Selinger  1 , Konstantina Rosiou  2 , Marco V Lenti  3
Affiliations
Review

Biological therapy for inflammatory bowel disease: cyclical rather than lifelong treatment?

Christian Philipp Selinger et al. BMJ Open Gastroenterol. .

Abstract

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.

Keywords: CROHN'S DISEASE; INFLAMMATORY BOWEL DISEASE; TNF-ALPHA; ULCERATIVE COLITIS.

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Conflict of interest statement

Competing interests: CPS has received unrestricted research grants from Warner Chilcott, Janssen, Galapagos and AbbVie, has provided consultancy to Warner Chilcott, Dr Falk, AbbVie, Takeda, Fresenius Kabi, Eli Lilly, Galapagos, Ferring, Arena and Janssen, and had speaker arrangements with Warner Chilcott, Dr Falk, Galapagos, AbbVie, MSD, Pfizer, Eli Lilly, BMS, UCB, Fresenius Kabi, Celltrion and Takeda.The other authors have no conflict of interests to disclose.

Figures

Figure 1
Figure 1
Proposed flow chart for consideration of de-escalation of anti-tumour necrosis factor (TNF) therapy.
See this image and copyright information in PMC

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