Treatment of Inflammatory Bowel Disease with Biologics

325

to discontinue biologic therapy should therefore be individualized, taking into
account disease phenotypes, preceding disease course, and potential consequences
of disease relapse [ 56 ]. Critical to any discussion about biologic discontinuation
should be a plan for disease activity monitoring over time, in order to potentially
identify subclinical evidence of relapse and potentially allow for intervention before
significant disease recurrence. Reassuringly, response to re-treatment with anti-
TNF therapy is likely to be effective in patients who relapse after discontinuation,
but immunogenicity may render re-treatment unpredictably less effective [ 57 ].

Follow-Up Assessments

Close follow-up is needed when biologic therapy is stopped, although the most
appropriate way to optimally monitor these patients is not clear [ 58 ]. Monitoring of
CRP and fecal calprotectin levels regularly (i.e., every 3 months) may be useful for
predicting early clinical relapse, and a significant increase of these biomarker values
may predict a relapse during the next few months [ 59 , 60 ]. Colonoscopy and/or
cross-sectional imaging may be appropriate at a prespecified interval after discon-
tinuation, to assess disease activity (i.e., 1 year).
Overall, maximizing effectiveness and minimizing adverse effects of biologic
therapies require attention to disease activity monitoring, assessment for adverse
effects, and shared decision-making with patients. Careful, individualized patient
assessment is necessary. Giving the right treatment to the right patient at the right
time and in the right way has the inherent appeal of maximizing efficacy in those
who are most likely to respond, while avoiding potentially costly and toxic therapy
in patients who are less likely to benefit [ 61 ].

References

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18 Quality, Safety, and Practical Considerations of Using Biologic Therapies