Treatment of Moderate-to-Severe Crohn's Disease in Corticosteroid-Free Remission on Combination Therapy
When an adult with moderate-to-severely active Crohn's disease has achieved sustained corticosteroid-free remission on combination therapy with a TNF antagonist and an immunomodulator, an important clinical question arises: can the regimen be safely adjusted — and if so, how?
Clinical Scenario
Adult outpatient with moderate-to-severely active Crohn's disease who is in corticosteroid-free clinical remission for at least 6 months while on combination therapy with a TNF antagonist and an immunomodulator. The protocol addresses whether this regimen can be modified without risking relapse.
Clinical Goal
Maintenance of corticosteroid-free clinical remission without relapse at 12 months.
Evidence-Based Approach
AGA guidance provides a specific recommendation on de-escalating combination therapy in this stable-remission setting — with evidence-based direction on which component of the regimen can be reconsidered and which must be preserved. The structured protocol details the recommended course of action.
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References
- In adult outpatients with moderate-to-severely active CD who are in corticosteroid-free clinical remission for at least 6 months on combination therapy with TNF antagonists and an immunomodulator, the AGA SUGGESTS withdrawing the IMMUNOMODULATOR.
- In adult outpatients with moderate-to-severely active Crohn's disease who are in corticosteroid-free clinical remission for at least 6 months on combination therapy of TNF antagonists and an immunomodulator, the AGA suggests AGAINST withdrawal of the TNF ANTAGONIST.
- There was no significant difference in the overall risk of relapse with immunomodulator withdrawal compared with continued combination therapy (16.8% vs 14.9%; RR, 1.15; 95% CI, 0.75–1.76) (Supplementary Figure 12).
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