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

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 pediatric 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 pediatric 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.