From the Guidelines
The current rates of deprescribing in patients with Crohn's Disease vary significantly based on medication class, with the most recent and highest quality study suggesting that biologics like infliximab have discontinuation rates of approximately 20-40% within the first year of therapy, primarily due to loss of response, adverse effects, or remission achievement 1.
Deprescribing Rates by Medication Class
- Biologics: 20-40% discontinuation rate within the first year of therapy, primarily due to loss of response, adverse effects, or remission achievement 1
- Immunomodulators: 30-50% discontinuation rate over similar timeframes, often due to side effects including hepatotoxicity and bone marrow suppression 1
- Corticosteroids: ideally have high deprescribing rates of 80-90% within 3-6 months to avoid long-term complications
Factors Influencing Deprescribing
- Sustained clinical remission (typically 6-12 months) 1
- Documented mucosal healing 1
- Patient age, comorbidities, and pregnancy planning 1
- Disease activity, medication efficacy, and side effect profile 1
Monitoring After Deprescribing
- Regular clinical assessments and fecal calprotectin measurements recommended every 3-6 months following deprescribing to detect early signs of relapse 1
- Careful monitoring is essential when discontinuing medications to minimize the risk of relapse and ensure timely intervention if necessary 1
From the Research
Current Rates of Deprescribing in Patients with Crohn's Disease
- There are no direct studies provided that report the current rates of deprescribing in patients with Crohn's Disease 2, 3, 4, 5, 6.
- The available studies focus on the efficacy and safety of various treatments for Crohn's disease, including azathioprine, 6-mercaptopurine, infliximab, and corticosteroids.
- These studies suggest that these treatments can be effective in inducing and maintaining remission in patients with Crohn's disease, but do not provide information on deprescribing rates.
Treatment Efficacy and Safety
- Azathioprine and 6-mercaptopurine have been found to be safe and efficacious in inducing remission of Crohn's disease in adults and children, with a therapeutic advantage over placebo 4.
- Infliximab, alone or in combination with azathioprine, has been shown to be effective in inducing corticosteroid-free clinical remission in patients with moderate-to-severe Crohn's disease 3.
- Corticosteroids are a well-established treatment for active Crohn's disease, but their use is associated with a range of side effects and a proportion of patients may be unable to withdraw from them without relapsing 5.
Limitations of Available Data
- The available studies do not provide information on deprescribing rates in patients with Crohn's disease.
- Further research is needed to determine the current rates of deprescribing in patients with Crohn's disease and to identify the factors that influence deprescribing decisions.