Combining NICE guidelines with exclusion criteria to identify patients with Crohn's disease for treatment withdrawal: 12-month prospective cohort study

Anti-tumour necrosis factor (anti-TNF) therapy is recognised as an effective treatment for inflammatory bowel disease (IBD). However, when to withdraw patients from treatment remains a matter of debate. This observational study, carried out in 2013, assessed the impact of applying National Institute for Health and Care Excellence (NICE) guidelines relating to this therapy to a local IBD service. Data was captured on 45 patients receiving infliximab or adalimumab. After applying the hospital's exclusion criteria, the data were matched with the NICE guidelines in place. Ten patients were deemed to be in remission and were withdrawn, two had dosing of adalimumab reduced from weekly to fortnightly, and investigations were ordered for the remaining patients. The audit provided up-to-date information on the demographics of patients receiving anti-TNF and a platform for clinical assessment. This article will discuss the NICE guidelines within the context of therapy withdrawal, their use in clinical practice and the unanswered questions they raise.