Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2015; 21(16): 4773-4778
Published online Apr 28, 2015. doi: 10.3748/wjg.v21.i16.4773
Withdrawal of anti-tumour necrosis factor α therapy in inflammatory bowel disease
Konstantinos Papamichael, Severine Vermeire
Konstantinos Papamichael, Severine Vermeire, Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders, 3000 Leuven, Belgium
Author contributions: Papamichael K wrote the manuscript; Vermeire S critically revised the manuscript; all authors approved the final version of the article.
Conflict-of-interest: Papamichael K has received a consultancy fee from MSD Hellas; and Vermeire S has received research funding from UCB Pharma, Abbvie and UCB Pharma, lecture fees from Abbott, Abbvie, MSD, Ferring Pharmaceuticals and UCB Pharma and consultancy fees from Pfizer, Ferring Pharmaceuticals, Shire Pharmaceuticals Group, MSD, and AstraZeneca Pharmaceuticals.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Konstantinos Papamichael, MD, PhD, FEBGH, Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders, Herestraat 49, 3000 Leuven, Belgium. konstantinos.papamichail@kuleuven.be
Telephone: +32-16-377557 Fax: +32-16-344419
Received: November 18, 2014
Peer-review started: November 19, 2014
First decision: December 11, 2014
Revised: January 7, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: April 28, 2015
Processing time: 160 Days and 1.5 Hours
Abstract

Anti-tumour necrosis factor α (anti-TNFα) therapy is an established treatment in inflammatory bowel disease. 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 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. This editorial is intended to provide an overview of recent data on this topic and shed light on the proposed drug withdrawal strategies.

Keywords: Inflammatory bowel disease; Anti-tumour necrosis factor α therapy; Withdrawal; Remission; Infliximab

Core tip: Anti-tumour necrosis factor α (anti-TNFα) therapy is an established treatment in inflammatory bowel disease. Although guidelines exist on initiation of anti-TNFα therapy in inflammatory bowel diseases, information on if, when, how and in whom therapy can be stopped is limited. This is nevertheless an important topic taking under consideration the cost and the possible adverse events associated with biological agents as well as the desire of patients to discontinue medication especially after a long maintained remission. Moreover, although drug discontinuation for reasons other than loss of response is very usual in real-life clinical practice, the optimal withdrawal strategy is still debated.