Long-term outcome of inflammatory bowel disease patients with deep remission after discontinuation of TNFα-blocking agents

Scand J Gastroenterol. 2017 Mar;52(3):284-290. doi: 10.1080/00365521.2016.1250942. Epub 2016 Nov 3.


Background: Little data exist on the long-term prognosis of patients with inflammatory bowel disease (IBD) after stopping TNFα-blocking therapy in deep remission. Existing data indicate that approximately 50% of patients on combination therapy who discontinued TNFα-blockers are still in remission 24 months later. The aims of this follow-up analysis were to evaluate the long-term remission rate after cessation of TNFα-blocking therapy, the predicting factors of a relapse and the response to restarting TNFα blockers.

Methods: The first follow-up data of 51 IBD patients (17 Crohn's disease [CD], 30 ulcerative colitis [UC] and four inflammatory bowel disease type unclassified [IBDU]) in deep remission at the time of cessation of TNFα-blocking therapy have been published earlier. The long-term data was collected retrospectively after the first follow-up year to evaluate the remission rate and risk factors for the relapse after a median of 36 months.

Results: After the first relapse-free year, 14 out of the remaining 34 IBD patients relapsed (41%; 5/12 [42%] CD and 9/22 [41%] UC/IBDU). Univariate analysis indicated no associations with any predictive factors. Re-treatment was effective in 90% (26/29) of patients.

Conclusion: Of IBD patients in deep remission at the time of cessation of TNFα-blocking therapy, up to 60% experience a clinical or endoscopic relapse after a median follow-up time of 36 months (95% CI 31-41 months). No individual risk factors predicting relapse could be identified. However, the initial response to a restart of TNFα-blockers seems to be effective and well tolerated.

Keywords: Crohn’s disease; TNFα-antagonist; adalimumab; infliximab; relapse; stopping; ulcerative colitis.

Publication types

  • Multicenter Study

MeSH terms

  • Adalimumab / therapeutic use*
  • Adolescent
  • Adult
  • Child
  • Female
  • Finland
  • Follow-Up Studies
  • Humans
  • Inflammatory Bowel Diseases / classification
  • Inflammatory Bowel Diseases / drug therapy*
  • Infliximab / therapeutic use*
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Recurrence
  • Remission Induction
  • Retrospective Studies
  • Risk Factors
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Young Adult


  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Adalimumab