Abstract：
BACKGROUND: Biologic therapy is an effective treatment for inflammatory bowel disease [IBD]. However due to cost and safety concerns, dose de-escalation strategies after achieving remission have been suggested.
OBJECTIVE: To critically review available data on dose de-escalation of biologics [or other advanced therapies] in IBD. We will focus on studies evaluating de-escalation to standard dosing in patients initially optimised, and also on studies assessing de-escalation from standard dosing.
METHODS: A systematic bibliographic search was performed.
RESULTS: The mean frequency of de-escalation after previous dose intensification [12 studies, 1,474 patients] was 34%. The corresponding frequency of de-escalation from standard dosing [five studies, 3,842 patients] was 4.2%. The relapse rate of IBD following anti-tumour necrosis factor [TNF] de-escalation to standard dosing in patients initially dose-escalated [10 studies, 301 patients] was 30%. The corresponding relapse rate following anti-TNF de-escalation from standard dosing [nine studies, 494 patients] was 38%. The risk of relapse was lower for patients in clinical, biologic, and endoscopic/radiological remission at the time of de-escalation. A role of anti-TNF therapeutic drug monitoring in the decision to dose de-escalate has been demonstrated. In patients relapsing after de-escalation, re-escalation is generally effective. De-escalation is not consistently associated with a better safety profile. The cost-effectiveness of the de-escalation strategy remains uncertain. Finally, there is not enough evidence to recommend dose de-escalation of biologics different from anti-TNFs or small molecules.
CONCLUSIONS: Any consideration for de-escalation of biologic therapy in IBD must be tailored, taking into account the risks and consequences of a flare and patients\' preferences.
OBJECTIVE: To critically review available data on dose de-escalation of biologics [or other advanced therapies] in IBD. We will focus on studies evaluating de-escalation to standard dosing in patients initially optimised, and also on studies assessing de-escalation from standard dosing.
METHODS: A systematic bibliographic search was performed.
RESULTS: The mean frequency of de-escalation after previous dose intensification [12 studies, 1,474 patients] was 34%. The corresponding frequency of de-escalation from standard dosing [five studies, 3,842 patients] was 4.2%. The relapse rate of IBD following anti-tumour necrosis factor [TNF] de-escalation to standard dosing in patients initially dose-escalated [10 studies, 301 patients] was 30%. The corresponding relapse rate following anti-TNF de-escalation from standard dosing [nine studies, 494 patients] was 38%. The risk of relapse was lower for patients in clinical, biologic, and endoscopic/radiological remission at the time of de-escalation. A role of anti-TNF therapeutic drug monitoring in the decision to dose de-escalate has been demonstrated. In patients relapsing after de-escalation, re-escalation is generally effective. De-escalation is not consistently associated with a better safety profile. The cost-effectiveness of the de-escalation strategy remains uncertain. Finally, there is not enough evidence to recommend dose de-escalation of biologics different from anti-TNFs or small molecules.
CONCLUSIONS: Any consideration for de-escalation of biologic therapy in IBD must be tailored, taking into account the risks and consequences of a flare and patients\' preferences.
摘要：
背景：生物疗法是炎症性肠病（IBD）的有效治疗方法。然而,出于成本和安全考虑，在达到缓解后，已经提出了剂量递减策略。
目的：严格审查关于IBD中生物制剂（或其他先进疗法）剂量递减的现有数据。我们将专注于评估最初优化的患者降低至标准剂量的研究，以及评估标准剂量降级的研究。
方法：进行了系统的书目检索。
结果：先前剂量增强后的平均降频率（12项研究，1,474例患者）为34%。从标准剂量降低的相应频率(5项研究，3,842例患者）为4.2%。在最初剂量递增的患者中，抗TNF降低至标准剂量后IBD的复发率（10项研究，301例患者)为30%。抗TNF从标准剂量降低后的相应复发率（9项研究，494例患者)为38%。临床上患者的复发风险较低，生物学，和内镜/放射学缓解时的降级。已经证明了抗TNF治疗药物监测在剂量递减决定中的作用。在降级后复发的患者中，重新升级通常是有效的。降级并不总是与更好的安全性相关联。降级战略的成本效益仍然不确定。最后,没有足够的证据推荐不同于抗-TNFs或小分子的生物制剂的剂量递减.
结论：必须针对IBD中生物治疗降级的任何考虑，考虑到耀斑的风险和后果以及患者的偏好。
目的：严格审查关于IBD中生物制剂（或其他先进疗法）剂量递减的现有数据。我们将专注于评估最初优化的患者降低至标准剂量的研究，以及评估标准剂量降级的研究。
方法：进行了系统的书目检索。
结果：先前剂量增强后的平均降频率（12项研究，1,474例患者）为34%。从标准剂量降低的相应频率(5项研究，3,842例患者）为4.2%。在最初剂量递增的患者中，抗TNF降低至标准剂量后IBD的复发率（10项研究，301例患者)为30%。抗TNF从标准剂量降低后的相应复发率（9项研究，494例患者)为38%。临床上患者的复发风险较低，生物学，和内镜/放射学缓解时的降级。已经证明了抗TNF治疗药物监测在剂量递减决定中的作用。在降级后复发的患者中，重新升级通常是有效的。降级并不总是与更好的安全性相关联。降级战略的成本效益仍然不确定。最后,没有足够的证据推荐不同于抗-TNFs或小分子的生物制剂的剂量递减.
结论：必须针对IBD中生物治疗降级的任何考虑，考虑到耀斑的风险和后果以及患者的偏好。
