CHANGING THERAPY TO ACHIEVE ENDOSCOPIC HEALING IN ASYMPTOMATIC PATIENTS WITH IBD: WHEN IS PERFECT THE ENEMY OF GOOD?

Abstract INTRODUCTION The treat-to-target strategy for inflammatory bowel disease (IBD) recommends optimizing or changing therapy in patients who have not achieved clinical remission and endoscopic healing. In asymptomatic patients, the potential benefit of changing therapy to achieve endoscopic healing is less clear, particularly since 65 years and the possibility of pregnancy within the next year influenced treatment decision-making. Initial ratings were collected via online anonymous survey, discussed at an in-person meeting, and collected as final ratings in a second anonymous survey using a modified Delphi approach. Disagreement was assessed using a validated index. RESULTS Panelists rated it appropriate to change therapy (i.e., expected benefit sufficiently exceeds expected negative consequences) in 96/126 scenarios, generally those with progressive, complicated, and/or extensive disease; 27 scenarios of patients with mild and/or stable disease were rated uncertain, particularly in those with prior exposure to ≥3 drug classes (Table). Changing therapy in asymptomatic patients was rated inappropriate in three scenarios: in patients with UC Mayo 1 disease previously treated with ≥3 therapy classes with no endoscopic progression in the last year; in any patient who showed endoscopic improvement over the last year; and in any patient with CD who had only scattered aphthous ulcers. Patient age >65 years influenced a decision to change therapy specifically for anti-TNFs and JAK inhibitors; the possibility of pregnancy also influenced decision-making. Despite variability in ratings, the thresho