Discontinuing anti-tumor necrosis factor-α treatment (anti-TNF) in patients with inflammatory bowel disease (IBD) may possess a high relapse risk and may be influenced by endoscopic activity at the time of stopping. A recent study assessed the relapse rate after anti-TNF withdrawal in patients with endoscopic healing and studied predictors of relapse, including the depth of endoscopic healing.

This multicenter, prospective study included adult patients with Crohn′s disease (CD), ulcerative colitis (UC), or IBD-unclassified (IBDU), with ≥6 months of corticosteroid-free clinical remission (confirmed at baseline) and endoscopic healing (Mayo <2/SES-CD <5 without large ulcers), who discontinued anti-TNF between 2018 and 2020. It assessed the relapse rate and evaluated potential predictors: partial (Mayo 1/SES-CD 3-4) versus complete (Mayo 0/SES-CD 0-2) endoscopic healing, anti-TNF trough levels, and immunomodulator and/or mesalamine use.

The study found-

• Relapse in 49% of the patients with a median follow-up of 2.0 years. 
• A comparable Relapse rate in CD and UC/IBDU patients.
• Relapse in 70% versus 35% of patients with partial versus complete endoscopic healing, respectively, at 12 months. 
• Fewer relapses in UC/IBDU patients with Mesalamine use.
• Regaining clinical remission at three months in 73% among thirty patients who restarted anti-TNF.

This study described a high relapse risk after anti-TNF withdrawal in IBD patients with endoscopic healing. However, the majority of them regained remission after anti-TNF reintroduction. Furthermore, complete endoscopic healing and mesalamine treatment in UC/IBDU patients reduced the risk of relapse.

Clin Gastroenterol Hepatol. 2022 Aug 31:S1542-3565(22)00820-5. doi: 10.1016/j.cgh.2022.08.024. Epub ahead of print. PMID: 36055567.