Relapse Rates High in IBD Patients Who Stop Treatment

Inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn’s disease, are chronic disorders of the gastrointestinal tract which require long term treatment to achieve remission, and to prevent relapses. While current therapies are effective, many concerns exist regarding their long term use. Recently, a new area of research has emerged, namely, the question of the optimal duration of treatment in IBD. Dr William Tremaine, M.D., provides valuable insight on a review article published in Gastroenterology, and sheds some light on the relapse rates after withdrawal of well-established therapy in IBD patients.

Frequently, patients raise the question of stopping medication during remission of IBD. There may be several reasons to consider cessation of  treatment: 1) the high cost of medications, 2) the potential for rare, but serious side effects, such as infection or lymphoma, and 3) the possibility that the patient can maintain a durable remission off treatment. In this study, researchers concluded that early discontinuation of an effective treatment can lead to a high relapse rate:

• After 1 year, the relapse rate in IBD patients is 50%
• After 5 years, the relapse rate increases to over 70%
• After 10 years, the relapse rate is nearly 90%

Researchers also looked at a subset of IBD patients who may be better candidates for drug discontinuation. Dr. Tremaine explains:

• IBD patients in a deep, prolonged remission may represent a group that could stop medication.
• Patients with lower blood level measures of the drugs could conceivably discontinue treatment.
• Reduced rates of relapse were also noted with increasing age, for individuals 65 years and older.

As a final conclusion, the relapse rates in patients with inflammatory bowel disease who discontinued treatment are generally high; however, in case of specific patients, the discontinuation of therapy can be considered the challenge for future research.

Read the full article online here.

For more information about IBD, visit mayoclinic.org/ibd.

Dr. Tremaine is a gastroenterologist at Mayo Clinic.