P430 European clinician perspective on withdrawing immunosuppression
R. Boyapati1, S. R. Fehily*2, N. S. Ding3
1Monash Medical Centre, Gastroenterology, Melbourne, Australia, 2St Vincent's Hospital, Gastroenterology, Melbourne, Australia, 3St Vincent’s Hospital, Gastroenterology, Melbourne, Australia
Treating to target in inflammatory bowel disease is achieved through early immunosuppression with rapid escalation to combination therapy. Short-term studies support de-escalation to mono-therapy in certain contexts, however long-term outcomes of withdrawing immunosuppression are unknown.1,2 We aimed to assess clinician perspective on, and current barriers to, withdrawing immunosuppression in European practice.
500 questionnaires were distributed to workshop participants at the 11th Congress of European Crohn’s and Colitis Organisation (ECCO). Likelihood of withdrawing IBD therapies, as well as clinician and patient factors associated with cessation, and barriers to withdrawal were recorded.
Responses were obtained from 132 attendees. 108 clinicians [median age 37 (IQR33–46), 66.7% female] adequately completed surveys from 37 countries with varying levels of clinical experience [median years 6; IQR (3–15)]. Patient–clinician discussion around ceasing immunosuppressive therapy was infrequently raised by both clinicians and patients. The likelihood of ceasing mesalazine monotherapy was greater compared with any biologic agents (
A reluctance to both de-escalate and cease IBD therapy as part of routine practice prevails across Europe. Further long-term prospective studies are required to evaluate the outcomes of complete immunosuppression withdrawal.
1. Boyapati RK, Torres J, Palmela C,
2. Van Assche G, Magdelaine-Beuzelin C, D’Haens G