Anti-TNF Agents and New Biological Agents (Vedolizumab and Ustekinumab) in the Prevention and Treatment of Postoperative Recurrence After Surgery in Crohn’s Disease

Gisbert, Javier P.; Chaparro, María

doi:10.1007/s40265-023-01916-2

Drugs

2023

DOI: 10.1007/s40265-023-01916-2

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Anti-TNF Agents and New Biological Agents (Vedolizumab and Ustekinumab) in the Prevention and Treatment of Postoperative Recurrence After Surgery in Crohn’s Disease

Javier P. Gisbert,

María Chaparro

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Cited by 3 publications

References 166 publications

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The Management of Postoperative Recurrence in Crohn’s Disease

Power,

Barnes

2023

Curr Treat Options Gastro

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The Management of Postoperative Recurrence in Crohn’s Disease

Power,

Barnes

2023

Curr Treat Options Gastro

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De-escalation of Biologic Treatment in Inflammatory Bowel Disease: A Comprehensive Review

Gisbert,

Chaparro

2023

Journal of Crohn's and Colitis

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Introduction Biologic therapy is an effective treatment for inflammatory bowel disease [IBD]. However due to cost and safety concerns, dose de-escalation strategies after achieving remission have been suggested. Aim To critically review available data on dose de-escalation of biologics [or other advanced therapies] in IBD. We will focus on studies evaluating de-escalation to standard dosing in patients initially optimised, and also on studies assessing de-escalation from standard dosing. Methods A systematic bibliographic search was performed. Results The mean frequency of de-escalation after previous dose intensification [12 studies, 1,474 patients] was 34%. The corresponding frequency of de-escalation from standard dosing [five studies, 3,842 patients] was 4.2%. The relapse rate of IBD following anti-tumour necrosis factor [TNF] de-escalation to standard dosing in patients initially dose-escalated [10 studies, 301 patients] was 30%. The corresponding relapse rate following anti-TNF de-escalation from standard dosing [nine studies, 494 patients] was 38%. The risk of relapse was lower for patients in clinical, biologic, and endoscopic/radiological remission at the time of de-escalation. A role of anti-TNF therapeutic drug monitoring in the decision to dose de-escalate has been demonstrated. In patients relapsing after de-escalation, re-escalation is generally effective. De-escalation is not consistently associated with a better safety profile. The cost-effectiveness of the de-escalation strategy remains uncertain. Finally, there is not enough evidence to recommend dose de-escalation of biologics different from anti-TNFs or small molecules. Conclusions Any consideration for de-escalation of biologic therapy in IBD must be tailored, taking into account the risks and consequences of a flare and patients’ preferences.

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Postoperative small bowel Crohn's disease: how to diagnose, manage and treat

Ip,

Boyapati,

Kalla

2024

Current Opinion in Gastroenterology

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Purpose of review Crohn's disease is a relapsing inflammatory condition and disease recurrence after surgery is common. Significant variation in clinical practice remains despite progress in management of postoperative Crohn's disease. In this review, we summarise current management strategies and guidelines, unmet needs, and research progress in this field. Recent findings There has been real progress in risk stratifying individuals’ postsurgery and tailoring therapies based on their risk; this has been incorporated into current management guidelines in the USA, UK, and Europe. Furthermore, novel noninvasive monitoring tools such as intestinal ultrasound have shown high sensitivity and specificity at detecting disease recurrence and are an attractive point-of-care test. Recent studies are also investigating multiomic biomarkers to prognosticate postoperative Crohn's disease. However, given the heterogeneity within this condition, large multicentre clinical validation across all age groups is needed for clinical translation in the future. Summary Ongoing progress in research and the development of novel prognostic and noninvasive disease monitoring tools offers hope for personalised therapy tailored to individual recurrence risk in postoperative Crohn's disease.

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Anti-TNF Agents and New Biological Agents (Vedolizumab and Ustekinumab) in the Prevention and Treatment of Postoperative Recurrence After Surgery in Crohn’s Disease

Cited by 3 publications

References 166 publications

The Management of Postoperative Recurrence in Crohn’s Disease

The Management of Postoperative Recurrence in Crohn’s Disease

De-escalation of Biologic Treatment in Inflammatory Bowel Disease: A Comprehensive Review

Postoperative small bowel Crohn's disease: how to diagnose, manage and treat

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