When and how to stop anti-TNF treatment in inflammatory bowel disease: Predictors of relapse after stopping treatment

The global benefit-risk ratio of long-term anti-TNF treatment appears favorable. Nevertheless, reasons exist for contemplating treatment cessation, including patient preference, associated side effects, the development of infection in high-risk patients, pregnancy and cost. Several prospective studies have shown very consistent relapse rates of around 50% at 1 year. Globally, patients with a low risk of relapse are those with steroid-free, clinical, endoscopic and biological remission of Crohn's disease, while no clear predictor has been identified in ulcerative colitis. These studies as well as larger retrospective studies have also shown excellent responses and remission rates and very good tolerabilities of retreatment with the same anti-TNF agents, particularly when patients are concomitantly treated with an immunosuppressant. © 2015 by S. Karger AG. All rights reserved.