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

Table 1 Studies on the discontinuation of anti-tumor necrosis factor α therapy in inflammatory bowel disease

IBD type	Anti-TNFαtherapy	n	Median follow up, mo	SCR at the end of follow up, %	Clinical benefit after re-introduction of anti-TNFαtherapy for relapse, %	Ref.
CD	IFX	115	28	55	88	[3]
CD	IFX	48	49	35	ND	[4]
CD	IFX	53	18	12	96	[7]
UC	IFX	28	29	40	71	[7]
CD	IFX or ADM	121	12	55	55	[11]
UC	IFX	51	12	65	94	[13]
CD	IFX or ADM	37	1-44 (range)	26 (1 yr)	ND	[10]
CD	IFX or ADM	17	13	71	100	[9]
UC	IFX	34	13	65	90	[9]
CD	IFX	100	120	52	ND	[6]
CD	IFX or ADM	86	17	64 (1 yr)	93	[12]
CD	IFX	92	47	28	89	[5]

IBD: Inflammatory bowel disease; CD: Crohn’s disease; UC: Ulcerative colitis; IFX: Infliximab; ADM: Adalimumab; TNFα: Tumor necrosis factor α; ND: Not defined; SCR: Sustained clinical remission.

Table 2 Risk factors for relapse after stopping anti-tumor necrosis factor α therapy for remission (clinical or endoscopic) in inflammatory bowel disease

Risk factors	Ref.
Clinical or phenotypic
Corticosteroid use between 12 and 6 mo before baseline	[3]
Male gender	[3]
Absence of previous surgical resection	[3]
Longer disease duration from diagnosis to first infliximab	[7]
Previous biological therapy	[11-13]
Dose intensification during the first year of anti-TNFα therapy	[11]
Age at CD diagnosis ≥ 25 yr	[6]
Ileocolonic disease at diagnosis	[12]
Active smoking	[5]
Previous antimetabolite failure	[5]
Perianal disease	[5]
Serological1
Hemoglobin levels ≤ 14.5 g/dL	[3]
White blood count > 6 × 109/L	[3]
High sensitive CRP ≥ 5 mg/L	[3]
Infliximab trough levels ≥ 2 μg/mL	[3]
Serum calprotectin > 5675 ng/mL	[37]
Endoscopic1
CDEIS > 0	[3]
Mucosal1
Lack of normalization of IL-17A and TNFα expression levels	[10]
Microbiological1 (CD-associated dysbiosis)
Low rate of Faecalibacterium prausnitzii in fecal samples	[38]
Low rate of Bacteroides in fecal samples	[38]
Fecal1
Fecal calprotectin ≥ 300 μg/g	[3]
Genetic
Fc gamma receptor IIIB-NA2/NA2 genotype (fistulising disease)	[39]

¹At the time of anti-TNFα therapy discontinuation. CD: Crohn’s disease; CRP: C-reactive protein; CDEIS: Crohn’s Disease Endoscopic index of severity; IL: Interleukin; NA: Neutrophil antigen; TNFα: Tumor necrosis factor α.