Abstract
When to stop anti-TNF therapy in Crohns disease (CD)? This is a very important question both for patients and physicians. There is no published evidence to clearly and definitely answer this question. However data on natural history of CD, long term safety of biologics, outcome after immunosuppressors (IS) cessation and some preliminary studies on biologics cessation may help us to discuss this topic. One could argue that there is currently no good reason to stop anti-TNF therapy in a patient who is in stable remission and can tolerate this drug very well. The decision to stop an anti-TNF treatment is thus currently based on a compromise between the benefits/risks and cost of such long term treatment. While it appears now clearly that prolonged anti-TNF therapy is associated with favourable outcome with sustained remission, reduced surgeries and hospitalisation as well as absence of significant increase in mortality or cancers, the cost-effectiveness which is probably favourable for short and mid-term treatment (up to one year), may be less optimal for very long term treatment. In this perspective however, prospective studies should be performed to adequately assess long term evolution, disease outcome, safety and global cost of strategies based on treatment reduction with IS maintenance alone or even full treatment cessation.
Keywords: Infliximab, adalimumab, certolizumab pegol, Crohn's disease, therapy, biomarkers, mucosal healing
Current Drug Targets
Title: Anti-TNF and Crohns Disease: When Should We Stop?
Volume: 11 Issue: 2
Author(s): Edouard Louis, Jacques Belaiche and Catherine Reenaers
Affiliation:
Keywords: Infliximab, adalimumab, certolizumab pegol, Crohn's disease, therapy, biomarkers, mucosal healing
Abstract: When to stop anti-TNF therapy in Crohns disease (CD)? This is a very important question both for patients and physicians. There is no published evidence to clearly and definitely answer this question. However data on natural history of CD, long term safety of biologics, outcome after immunosuppressors (IS) cessation and some preliminary studies on biologics cessation may help us to discuss this topic. One could argue that there is currently no good reason to stop anti-TNF therapy in a patient who is in stable remission and can tolerate this drug very well. The decision to stop an anti-TNF treatment is thus currently based on a compromise between the benefits/risks and cost of such long term treatment. While it appears now clearly that prolonged anti-TNF therapy is associated with favourable outcome with sustained remission, reduced surgeries and hospitalisation as well as absence of significant increase in mortality or cancers, the cost-effectiveness which is probably favourable for short and mid-term treatment (up to one year), may be less optimal for very long term treatment. In this perspective however, prospective studies should be performed to adequately assess long term evolution, disease outcome, safety and global cost of strategies based on treatment reduction with IS maintenance alone or even full treatment cessation.
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Cite this article as:
Louis Edouard, Belaiche Jacques and Reenaers Catherine, Anti-TNF and Crohns Disease: When Should We Stop?, Current Drug Targets 2010; 11 (2) . https://dx.doi.org/10.2174/138945010790309957
DOI https://dx.doi.org/10.2174/138945010790309957 |
Print ISSN 1389-4501 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-5592 |
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