European Crohn's and Colitis Organisation Topical Review on Treatment Withdrawal ('Exit Strategies') in Inflammatory Bowel Disease

Doherty G1, Katsanos KH2, Burisch J3, Allez M4, Papamichael K5, Stallmach A6, Mao R7, Berset IP8, Gisbert JP9, Sebastian S10, Kierkus J11, Lopetuso L12, Szymanska E13, Louis E14. J Crohns Colitis. 2017 Aug 2. doi: 10.1093/ecco-jcc/jjx101. [Epub ahead of print]
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1 Centre for Colorectal Disease, St Vincent's University Hospital & University College Dublin, Ireland. 2 Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece. 3 Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark. 4 Department of Gastroenterology and Hepatology, Hôpital Saint-Louis, APHP, INSERM UMRS 1160, Université Denis Diderot, Paris, France. 5 Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. 6 Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Disease), University Hospital Jena, Jena, Germany. 7 Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 8 Gastroenterology Department, Alesund Hospital, Helse More Romsdal Hospital Trust, Alesund, Norway. 9 Department of Gastroenterology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. 10 IBD Unit, Department of Gastroenterology, Hull & East Yorkshire Hospitals NHS Trust, Hull, United Kingdom. 11 Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, Children's Memorial Health Institute, Warsaw, Poland. 12 Department of Gastroenterology and Internal Medicine, Catholic University of Rome-A. Gemelli Hospital, Rome, Italy. 13 Department of Pediatrics, Nutrition, and Metabolic Disorders, Children's Memorial Health Institute, Warsaw, Poland. 14 Department of Gastroenterology, CHU Liège, Sart Tilman, Liège, Belgium.


Clinically effective therapies now exist for remission maintenance in both ulcerative colitis (UC) and Crohn's Disease (CD). For each major class of IBD medications (5-aminosalicyclates, immunomodulators and biologic agents), used alone or in combination, there is a risk of relapse following reduction or stopping of treatment. A consensus expert panel convened by the European Crohn's and Colitis Organisation (ECCO) reviewed the published literature and agreed a series of consensus practice points. The objective of the expert consensus is to provide evidence-based guidance for clinical practice so that physicians can make informed decisions in partnership with their patients. The likelihood of relapse with stopping each class of IBD medication is reviewed. Factors associated with an altered risk of relapse with withdrawal are evaluated and strategies to monitor and allow early identification of relapse are considered. In general, patients in clinical, biochemical and endoscopic remission are more likely to remain well when treatments are stopped. Reintroduction of the same treatment is usually, but not always, successful. The decision to stop a treatment needs to be individualized and shared decision making with the patient should take place.

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