Crohns & Colitis Congress

Crohns & Colitis Congress

Source:

Rosh, JR. Presentation: “De-escalation” of therapy in pediatric IBD. Presented at: Crohn’s and Colitis Congress; Jan. 20-22, 2022 (virtual meeting).

Disclosures: Rosh reports grant/research support from AbbVie and Janssen, as well as consulting for BMS, Janssen, Lilly and Pfizer.
January 21, 2022
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Transition to long-term IBD care relies on open communication, patient monitoring

Source:

Rosh, JR. Presentation: “De-escalation” of therapy in pediatric IBD. Presented at: Crohn’s and Colitis Congress; Jan. 20-22, 2022 (virtual meeting).

Disclosures: Rosh reports grant/research support from AbbVie and Janssen, as well as consulting for BMS, Janssen, Lilly and Pfizer.
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Therapeutic “de-escalation” relies on analysis of disease-related factors and careful monitoring of pediatric patients with inflammatory bowel disease, according to a presentation at the Crohn’s and Colitis Congress.

“The question of therapeutic de-escalation in pediatric IBD arises so often in clinical care with the common misconception that feeling better equates to being in endurable remission, rather than it simply being a sign that the medication is working,” Joel R. Rosh, MD, director of pediatric gastroenterology at Goryeb Children's Hospital in New Jersey, told attendees.

Rosh’s to-do list for transitioning to long-term IBD care: 1.	Confirm clinical, radiographic, endoscopic and histologic deep remission 2.	Establish a drug-level monitoring plan at baseline  3.	Create a disease-monitoring plan  4.	Lead discussion on risks and benefits for shared decision-making

Another fear Rosh often hears from patients and their families is that prolonged use of medications? will ultimately lead to adverse side effects, despite data proving the exact opposite. “We need to keep educating our patients that what we have today in 2022 are highly effective therapies, but we do not yet have cure,” he said. “Highly effective therapy means as long as you stay on this, you're going to feel normal and you're going to be normal.”

The term “de-escalation” in and of itself can be misleading, Rosh said, because it encompasses change in medication course related to factors other than how a patient feels. He has instead coined an alternative term, “transition to long-term care,” citing changes in disease behavior, age and side effects, including immunogenicity, cost and patient preference, as additional factors.

Although a patient’s medication course is ultimately at their discretion, transitioning to long-term care weighs the risk for therapy vs. the risk for disease. Or, in other words, the risk for relapse.

Rosh’s to-do list for transitioning to long-term care includes:

confirm clinical, radiographic, endoscopic and histologic deep remission;

establish a drug-level monitoring plan at baseline to evaluate either dose reduction or switching from combination therapy to monotherapy;

create a disease-monitoring plan to ensure whatever is done can be undone if disease activity spikes; and

lead discussion on risks and benefits of de-escalation for shared decision-making between patient and provider.

“This is a great opportunity to talk to your patients,” Rosh concluded. “Educate them about goals of therapy and really force yourself to make sure that at every visit you're optimizing their therapy, you're optimizing their dosing and you’re monitoring their disease.”