ECCO Topical Review on Biological Treatment Cycles in Crohn's Disease.

Nurulamin M Noor, Paula Sousa, Dominik Bettenworth, Fernando Gomollón, Triana Lobaton, Peter Bossuyt, Maria Jose Casanova, Nik S Ding, Gabriele Dragoni, Federica Furfaro, Patrick F van Rheenen, Maria Chaparro, Javier P Gisbert, Edouard Louis, Konstantinos Papamichail

Journal: Journal of Crohn's & colitis 2023;17(7):1031-1045

PMID: 36626338

Free Full Text on ORBi (University of Liege) View on PubMed

Abstract

There are now a growing number of licensed biological therapies for patients with Crohn's disease. However, there can be significant costs associated with long-term maintenance treatment, as well as some concerns about potential side-effects. As a result, there has been increasing interest in elective biological treatment discontinuation in selected patients, after a sustained period of remission. Following discontinuation, in cases of relapse, evidence to date has suggested that remission may often be regained by re-treatment with the same biological agent. Therefore, a concept has emerged in which cycles of biological therapy might be used. If this treatment strategy were to be applied in a subgroup of patients at low risk of relapse, cycling might allow a substantial number of patients to have a lower, overall therapeutic burden-ensuring decreased exposure to biological therapy but still enabling appropriate disease control. Currently, there remains uncertainty about the benefit-risk balance for using cycles of biological treatment for patients with Crohn's disease. Accordingly, an expert panel was convened by the European Crohn's and Colitis Organisation [ECCO] to review the published literature and agree a series of consensus practice points. The panel aimed to provide evidence-based guidance on multiple aspects of biological treatment discontinuation and cycling, including the risk of relapse after elective treatment discontinuation, predictors of probable relapse or remission, safety, patient preferences, and pharmacoeconomic aspects. Crucially, discussions about biological treatment discontinuation and cycling should be individualized, to enable shared decision-making by patients with their clinicians.

Address: Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.; Medical Research Council Clinical Trials Unit, University College London, London, UK.; Department of Gastroenterology, Viseu Unit, Tondela-Viseu Hospital Centre, 3504-509 Viseu, Portugal.; Medical Faculty of the University of Münster, Münster, NRW, Germany.; Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, CIBERehd Avenida San Juan Bosco 15, 50009 Zaragoza, Spain.; Aragón Health Research Institute (IIS Aragón), Avenida San Juan Bosco 9, 50009 Zaragoza, Spain.; University of Zaragoza, School of Medicine, Spain.; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.; Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium.; Imelda GI Clinical Research Centre, Department of Gastroenterology, Imelda General Hospital, Bonheiden, Belgium.; Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain.; Department of Gastroenterology, University of Melbourne, St Vincent's Hospital, Melbourne, Australia.; Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy.; IBD Referral Center, Gastroenterology Department, Careggi University Hospital, Florence, Italy.; Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Milan, Italy.; University of Groningen, Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen, The Netherlands.; Department of Hepato-Gastroenterology and Digestive Oncology, Liege University Hospital, CHU Liege, Belgium.; Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

DOI: 10.1093/ecco-jcc/jjad001