De-escalation of Therapy in Inflammatory Bowel Disease

  • Catarina Frias Gomes
  • Jean-Frédéric ColombelEmail author
  • Joana Torres
Inflammatory Bowel Disease (S Hanauer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Inflammatory Bowel Disease


Purpose of Review

Currently, inflammatory bowel disease treatment is based on immunomodulators (IM) and/or biologic as this strategy may prevent the development of irreversible damage. Nevertheless, long-term treatment may be associated with non-negligible side effects and with high costs, and therefore the question on whether therapy can be de-escalated is often posed in clinical practice.

Recent Findings

Recent studies have shown a predictable rate of relapse after stop biologic or IM therapy withdrawal. Overall, around 40–50% of patients will eventually relapse over the following year after drug withdrawal, and the rates will increase over time. Stratification of patients and therapeutic drug monitoring could be promising alternatives to guide therapeutic management.


We reviewed the current evidence on de-escalation strategy and summarised the recent results on discontinuation and dose reduction. Nowadays, de-escalation strategy is still a case-by-case decision in highly selected patients.


Immunomodulators Anti-TNF  Withdrawal Relapse Dose reduction Therapeutic drug monitoring 


Author Contributions

All authors contributed to the manuscript concept and design. CG reviewed the literature and drafted the manuscript. All authors critically revised the manuscript. All authors have approved the manuscript.

Compliance With Ethical Standards

Conflict of Interest

Joana Torres reports consulting fees from Takeda and AbbVie.

Jean-Frederic Colombel reports grants from Janssen and Janssen and Takeda; is working as a consultant and/or speaker for AbbVie, Amgen, Boehringer-Ingelheim, Ferring Pharmaceuticals, Genentech, Janssen and Janseen, Medimmune, Merck & Co., Nextbiotix, Novartis Pharmaceuticals Corporation, Otsuka Pharmaceutical Development and Commercialization, Inc., Pfizer, Protagonist, Second Genome, Gilead, Seres Therapeutics, Shire, Takeda, and Theradiag; and holds stock options with Intestinal Biotech Development and Genfit.

Catarina Frias Gomes declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Catarina Frias Gomes
    • 1
  • Jean-Frédéric Colombel
    • 2
    • 3
  • Joana Torres
    • 1
  1. 1.Surgical Department, Gastroenterology DivisionHospital Beatriz ÂngeloLouresPortugal
  2. 2.Medicine Department, Gastroenterology DivisionIcahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.The Henry D. Janowitz Division of GastroenterologyIcahn School of Medicine at Mount SinaiNew YorkUSA

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