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Background <p>Tumor necrosis factor (TNF) antagonists are central to the management of inflammatory bowel disease (IBD), but concerns regarding long-term safety, infection risk, and costs have prompted interest in treatment de-escalation. Whether discontinuing TNF therapy in patients with sustained remission is safe remains uncertain.</p> Methods <p>We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TNF antagonist withdrawal with continuation in IBD patients in sustained remission. Databases including MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched through July 2025. Eligible trials enrolled adults with Crohn’s disease or ulcerative colitis in clinical remission. Primary outcomes were relapse risk and sustained remission. Data were pooled using a random-effects model.</p> Results <p>Four RCTs comprising 485 patients were included. TNF antagonist withdrawal was associated with a significantly higher risk of relapse compared with continuation (RR: 3.00, 95% CI: 1.47–6.11). Time to relapse was also shorter in the withdrawal group (HR: 5.34, 95% CI: 2.05–13.92). Sustained clinical remission did not differ significantly between groups (RR: 0.83, 95% CI: 0.55–1.27). Withdrawal reduced infection risk (RR: 0.47, 95% CI: 0.25–0.90), while rates of gastrointestinal and serious adverse events were comparable.</p> Conclusions <p>Discontinuation of TNF antagonists in IBD patients in remission substantially increases the risk and accelerates the timing of relapse, though it lowers infection risk. Careful patient selection and close monitoring are essential if withdrawal is considered.</p>

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TNF antagonists withdrawal is not advised in patients with inflammatory bowel disease in remission: a systematic review and meta-analysis of randomized controlled trials

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月2日

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  • Ahmed Adekunle Owolabi,
  • Iqra Qazi,
  • Nadia Ahmed,
  • Mariam Amro Alsayed,
  • Muhammad Abu Zar,
  • Taimour Rashid Choudhry,
  • Dhanushan Gnanendran,
  • Aqsa Khan,
  • Amrutha Amrutha,
  • Huzaifa Ahmad Cheema,
  • Asma’a Munasar Ali Alsubari,
  • Essam Rashad,
  • Adnan Bhat,
  • Faryal Altaf,
  • Prasun K. Jalal

摘要

Background

Tumor necrosis factor (TNF) antagonists are central to the management of inflammatory bowel disease (IBD), but concerns regarding long-term safety, infection risk, and costs have prompted interest in treatment de-escalation. Whether discontinuing TNF therapy in patients with sustained remission is safe remains uncertain.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TNF antagonist withdrawal with continuation in IBD patients in sustained remission. Databases including MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched through July 2025. Eligible trials enrolled adults with Crohn’s disease or ulcerative colitis in clinical remission. Primary outcomes were relapse risk and sustained remission. Data were pooled using a random-effects model.

Results

Four RCTs comprising 485 patients were included. TNF antagonist withdrawal was associated with a significantly higher risk of relapse compared with continuation (RR: 3.00, 95% CI: 1.47–6.11). Time to relapse was also shorter in the withdrawal group (HR: 5.34, 95% CI: 2.05–13.92). Sustained clinical remission did not differ significantly between groups (RR: 0.83, 95% CI: 0.55–1.27). Withdrawal reduced infection risk (RR: 0.47, 95% CI: 0.25–0.90), while rates of gastrointestinal and serious adverse events were comparable.

Conclusions

Discontinuation of TNF antagonists in IBD patients in remission substantially increases the risk and accelerates the timing of relapse, though it lowers infection risk. Careful patient selection and close monitoring are essential if withdrawal is considered.