S Singh et al. Clin Gastroenterol Hepatol 2024; 22: 923-932. Open Access! Common Instances of Low-value Care in Inflammatory Bowel Diseases

• “Serological tests such as pANCA, ASCA, and other serological anti-microbial antibody tests for the diagnosis of IBD in patients with non-specific symptoms or in those with negative endoscopic and radiologic evaluation represents low-value care.“
• “Making major therapeutic decisions based only on the presence of symptoms in patients with IBD, particularly CD, without objective confirmation of inflammation, represents low-value care. “

• “Use of 5-ASA for the management of CD, particularly for patients at high risk of disease-related complications, represents low-value care. The safety of these medications must not be confused for their lack of efficacy in this setting. The utility of 5-ASA in a subset of patients with mild colonic CD who are at low risk of disease-related complications remains to be adequately studied.”
• “Routine continuation of oral 5-ASA in patients with IBD who have been escalated to advanced therapies represents low-value care. Selective use of 5-ASA, particularly topical therapy in patients with persistent symptoms of proctitis despite optimized biologics may be appropriate.”
• “Premature discontinuation of TNF antagonists in patients with IBD with partial but inadequate response or loss of response (after initial improvement) to index agent, without an attempt with accelerated dosing or therapeutic drug monitoring to potentially optimize therapy, represents low-value care.”
• “Failure to consider dose de-escalation of TNF antagonists in patients who have achieved stable and persistent remission with intensive dosing regimens may represent low-value care.“

“Prolonged use of high-dose intravenous corticosteroids beyond 5 to 7 days without significant clinical improvement, in patients hospitalized with ASUC, represents low-value care. In these patients, escalation to rescue medical therapy or surgery should be strongly considered.”

My take: If the comedian Jeff Foxworthy wrote this article, each of the opinions would have started off with ‘You might be wastin money if…’