Therapy de-escalation in paediatric patients with inflammatory bowel disease in remission: Data analysis from the CEDATA registry

Abstract

Objectives: There are no standardized criteria about stepping down from combination therapy (immunomodulator and tumor necrosis factor (TNF)-alpha-inhibitors) in children with inflammatory bowel disease (IBD) to reduce risk for side effects. Our aim was to describe how de-escalation has been performed in a large paediatric cohort and to find prognostic factors for therapy de-escalation without the need for therapy adjustments post-de-escalation. Methods: Real-world data from CEDATA-GPGE, a German-Austrian registry for paediatric IBD patients, from 2004 to 2023, were analyzed. Patients not requiring therapy adjustments post-de-escalation and patients requiring therapy adjustments after de-escalation were compared, and prognostic factors were identified. Results: Two hundred and thirty out of 6248 registered patients received combination therapy for at least 6 months. In 64 patients therapy adjustment was not required after de-escalation. Crohn's disease (CD) patients, younger patients, and patients with positive modified predictors of poor outcome were significantly more often on combination therapy. Regarding de-escalation, CD patients were more often successfully de-escalated than ulcerative colitis (UC) and IBD-unclassified patients. UC patients with a less severe disease manifestation (Paris classification E1 or E2) were de-escalated more successfully than those with more extensive disease (E3 or E4). De-escalation to monotherapy with a biologic led to a more successful de-escalation than de-escalation to immunomodulator monotherapy or stopping both biologic and immunomodulator. Conclusions: De-escalation is more likely successful in patients with CD, and de-escalating combination therapy to monotherapy with a TNF-alpha-inhibitor is more advantageous.