Withdrawal of anti-tumour necrosis factor α therapy in inflammatory bowel disease

Abstract

Anti-tumour necrosis factor α (anti-TNFα) therapy is an established treatment in inflammatory bowel disease. However, this treatment is associated with high costs and the possibility of severe adverse events representing a true challenge for patients, clinicians and health care systems. Consequently, a crucial question is raised namely if therapy can be stopped once remission is achieved and if so, how and in whom. Additionally, in a real-life clinical setting, discontinuation may also be considered for other reasons such as the patient’s preference, pregnancy, social reasons as moving to countries or continents with less access, or different local policy or reimbursement. In contrast to initiation of anti-TNFα therapy guidelines regarding stopping of this treatment are missing. As a result, the decision of discontinuation is still a challenging aspect in the use of anti-TNFα therapy. Currently this is typically based on an estimated, case-by-case, benefit-risk ratio. This editorial is intended to provide an overview of recent data on this topic and shed light on the proposed drug withdrawal strategies.

Keywords: Inflammatory bowel disease; Anti-tumour necrosis factor α therapy; Withdrawal; Remission; Infliximab

Core tip: Anti-tumour necrosis factor α (anti-TNFα) therapy is an established treatment in inflammatory bowel disease. Although guidelines exist on initiation of anti-TNFα therapy in inflammatory bowel diseases, information on if, when, how and in whom therapy can be stopped is limited. This is nevertheless an important topic taking under consideration the cost and the possible adverse events associated with biological agents as well as the desire of patients to discontinue medication especially after a long maintained remission. Moreover, although drug discontinuation for reasons other than loss of response is very usual in real-life clinical practice, the optimal withdrawal strategy is still debated.