INTRODUCTION: Deep remission (DR) is an emerging therapeutic target in inflammatory bowel disease (IBD). Although there is no consensus definition, many consider DR as clinical remission with mucosal healing with or without additional criteria. Anti-TNFα demonstrate increased success in achieving DR, which lead to longer periods of remission and improved outcomes. However, 30-50% patients in DR relapse within one and two years after anti-TNFα withdrawal. Furthermore, despite the availability of biosimilars, the decision to withdrawal anti-TNFα agents is greatly influenced by cost and limited access in certain countries. This meta-analysis assesses the response to retreatment with anti-TNFα in patients who previously achieved DR with anti-TNFα but subsequently stopped therapy and relapsed. METHODS: Search terms (“inflammatory bowel diseases” OR “IBD” OR “crohn*” OR “ulcerative colitis” OR “UC” OR “colitis”) AND (“mucosal healing” OR “deep remission” OR “complete remission” OR “full remission” OR “endoscopic remission”) produced 7,514 articles from Pubmed and EMBASE on Oct 1, 2018. Inclusion criteria were adult IBD patients in DR after treatment with anti-TNFα, defined as clinical remission and mucosal healing, who were followed until clinical or endoscopic relapse and subsequently restarted on anti-TNFα. Exclusion criteria were studies including children, patients on steroid maintenance, and non-English publications. Two authors independently reviewed publications for inclusion; a third author served as tie-breaker. Statistics was performed using OpenMetaAnalyst. RESULTS: Five publications with 73 cases were included. Retreatment with anti-TNFa successfully induced clinical remission in 94.4% (68/73; I2 = 0, P = 0.685) of all patients. No significant difference existed among ulcerative colitis (19/21) and Crohn's disease (49/52) patients. However, eight patients required either dose escalation of their prior anti-TNFα therapy, or were switched to another anti-TNFα agent. CONCLUSION: Literature reports deep remission to be more durable with improved outcome compared to clinical remission. Incorporation of anti-TNFα agents into treatment logarithm increase the likelihood of achieving DR. However, patients' preferences, medication cost, and healthcare policies may lead to treatment termination. This meta-analysis demonstrates that cessation of anti-TNFα is a viable option for patients with DR, as retreatment leads to clinical remission in an overwhelming majority of these patients.