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Optimising IBD patient selection for de-escalation of anti-TNF therapy to immunomodulator maintenance
  1. Rachael Swann,
  2. Alan Boal,
  3. Seth Ian Squires,
  4. Carly Lamb,
  5. Laura Louise Clark,
  6. Selina Lamont,
  7. Graham Naismith
  1. Department of Gastroenterology, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde Division, Glasgow, UK
  1. Correspondence to Dr Rachael Swann, Department of Gastroenterology, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde Clyde Division, Glasgow G51 4TF, UK; rswann{at}nhs.net

Abstract

Objective Inflammatory bowel disease (IBD) is increasingly managed with the use of biologic therapies. National guidelines (National Institute for Health and Care Excellence (NICE)) suggest considering cessation after 1 year of therapy but lack detailed criteria for this. We aimed to describe clinical outcomes from the introduction of a biologic review panel (BRP) to implement modified criteria for cessation of antitumour necrosis factor (anti-TNF) therapy and step down to single-agent immunomodulator.

Design Retrospective review of patient outcomes following BRP implementation.

Patients All patients on biologic therapy discussed in the BRP within a 5-year period.

Setting Single IBD network covering three hospital sites.

Interventions Modified criteria for biologic cessation were based on published evidence; they excluded individuals with no suitable maintenance immunomodulator, previous surgery or evidence of active disease, additional indications for anti-TNF therapy and previous relapse on biologic cessation. All patients with IBD on a biologic were discussed at the BRP.

Main outcome measures Relapse following IBD cessation and relative cost of BRP.

Results 136 patients with IBD were reviewed, with 45 patients meeting the NICE guideline criteria for cessation. The BRP and modified criteria affected decision to withdraw therapy in 38% of these. Therapy was withdrawn in 27 patients, with a 20% 24-month relapse rate. Younger age at cessation was significantly associated with relapse (p=0.01).

Conclusion The BRP approach has proved a safe and effective means of decision making in stopping biologic therapy. Future work to inform exclusion criteria is required.

  • biologic therapy
  • inflammatory bowel disease
  • health economics
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Footnotes

  • Contributors RS is the guarantor of the study. All authors (GN, SIS, RS, CL, AB, SL and LLC) participated in data collection and drafting the manuscript. The original idea for the study was devised by GN, AB and SIS, and further developed by RS. GN, SL, LLC, SIS and AB conducted the BRP intervention.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval As the review panel was introduced as part of a service development initiative and formed the standard of care for all patients, external ethical approval was not sought.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Raw anonymised data are available upon reasonable request from the corresponding author.

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