Exit strategies in inflammatory bowel disease:Looking beyond antitumor necrosis factors  

作　　者：Federica Crispino Andrea Michielan Mauro Grova Chiara Tieppo Marta Mazza Teresa Marzia Rogger Franco Armelao 

机构地区：[1]Azienda Provinciale per i Servizi Sanitari,Gastroenterology and Digestive Endoscopy Unit,Santa Chiara Hospital,Trento 38122,Italy [2]Inflammatory Bowel Disease Unit,Department of Medicine,Azienda Ospedaliera Ospedali Riuniti,Villa Sofia-Cervello,Palermo 90146,Italy

出　　处：《World Journal of Clinical Cases》2023年第12期2657-2669,共13页世界临床病例杂志

摘　　要：The long-term management of patients with inflammatory bowel disease(IBD)is still a matter of debate,and no clear guidelines have been issued.In clinical practice,gastroenterologists often have to deal with patients in prolonged remission after immunomodulatory or immunosuppressive therapies.When planning an exit strategy for drug withdrawal,the risk of disease relapse must be balanced against the risk of drug-related adverse events and healthcare costs.Furthermore,there is still a dearth of data on the withdrawal of novel biologics,such as the anti-α4β7 integrin antibody(vedolizumab)and anti-IL12/23 antibody(ustekinumab),as well as the small molecule tofacitinib.Models for estimating the risk of disease relapse and the efficacy of retreatment should be evaluated according to the patient's age and IBD phenotype.These models should guide clinicians in programming a temporary drug withdrawal after discussing realistic outcomes with the patient.This would shift the paradigm from an exit strategy to a holiday strategy.

关 键 词：Exit strategy Biologic withdrawal Drug holiday Vedolizumab USTEKINUMAB Tofacitinib 

分 类 号：R574[医药卫生—消化系统]