Gastrointestinal Therapeutics

Biography

Biography: Konstantinos Papamichail

Abstract

Anti-tumour necrosis factor alpha (anti-TNFα) therapy is an established treatment in inflammatory bowel disease (IBD) namely Crohn’s disease (CD) and ulcerative colitis (UC). However, this treatment is associated with high costs and the possibility of severe adverse events representing a true challenge for patients, clinicians and health care systems. Consequently, a crucial question is raised namely if therapy can be stopped once remission is achieved and if so, how and in whom. Additionally, in a real-life clinical setting, discontinuation may also be considered for other reasons such as the patient’s preference, pregnancy, social reasons as moving to countries or continents with less access, or different local policy or reimbursement. In contrast to initiation of anti-TNFα therapy guidelines regarding stopping of this treatment are missing as supporting data is lacking. There is even less information regarding prognostic factors that could predict relapse or sustained remission after anti-TNFα therapy discontinuation. The only provided evidence regarding CD comes from the landmark STORI trial and a few retrospective observational or small prospective studies, while for UC there are even less data available. As a result, the decision of discontinuation is still a challenging aspect in the use of anti-TNFα therapy. Currently this is typically based on an estimated, case-by-case, benefit-risk ratio as the optimal withdrawal strategy is still debated. Another important issue when considering cessation of anti-TNFα therapy is whether the drug can safely be restarted when needed and whether efficacy will be similar. Possible lower response rates after re-initiation of biological therapy, limited alternative treatment options and/or immunogenicity concerns are all factors which constitute to the fear of stopping treatment.