The dissertation "The Growing Gut" of Marleen Bouhuys explores strategies to optimise treatment and care for adolescents with inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. IBD causes chronic inflammation in the digestive tract, leading to symptoms like abdominal pain and diarrhoea. While biological medications, such as anti-TNF therapy, are essential for managing these conditions, they can involve frequent hospital visits, injections, and potential side effects, presenting significant challenges.
One potential approach to these challenges is anti_TNF de-escalation, which involves reducing the dosage or extending the intervals of medication. The ongoing FREE study aims to determine whether a lengthened anti-TNF dosing interval is non-inferior to the standard interval in maintaining remission. This innovative design allows patients with strong preferences for either the control or intervention group to choose their own strategy, alongside randomised participants. Additionally, the FREE study employs rapid blood tests to monitor drug levels, providing a practical alternative to traditional testing methods. Side effects are also compared between groups, with our systematic review indicating that de-escalation should not be considered solely to reduce these adverse effects.
For patients who do not respond well to anti-TNF therapy, off-label medications like ustekinumab present promising alternatives. We demonstrate the effectiveness of this drug in adolescents and investigate how they metabolise it. Finally, our findings show that telemonitoring is a safe and efficient way to manage IBD remotely, enhancing patient care and reducing the burden on hospitals.
