Long-term clinical outcomes after the discontinuation of anti-TNF agents in patients with inflammatory bowel disease: a meta-analysis.

Abstract

there are concerns regarding the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) therapy in patients with inflammatory bowel disease (IBD). We performed a systematic review and meta-analysis to evaluate the risk of relapse after discontination of anti-TNF agent in patients, and the reponse to retreatment with the same anti-TNF agent. electronic databases were searched to identify relevant studies. Primary outcomes were the pooled percentage of relapses after the withdrawal of anti-TNF agents. Secondary outcomes were the pooled percentage of the response to retreatment with the same anti-TNF agent after relapse. thirty seven studies were included in this meta-analysis. The overall risk of relapse after discontinuation of anti-TNF agent was 43% for UC and 43% for CD. In UC, the relapse rate was 37% at 1-2 year, 58% at 3-5 years. In CD, the relapse rate was 38% at 1-2 year, 53% at 3-5 years, 49% at more than 5 years. When clinical remission was the only criterion for stopping anti-TNF agent, the relapse rate was 42% in UC and 45% in CD, which decreased to 40% in UC and 36% in CD when clinical remission and endoscopic healing were required. Retreatment with the same anti-TNF agent induced remission again in 78% of UC patients and 76% of CD patients. our meta-analysis showed that a high proportion of IBD patients will relapse after discontinuation of anti-TNF agent. And response to retreatment with the same anti-TNF agent is generally favorable in patients who relapse.