Relapse rate and risk factors after anti-TNF withdrawal in UC

Cessation of anti-tumour necrosis factor (TNF) treatment in patients with ulcerative colitis (UC) in sustained corticosteroid-free clinical remission is associated with a considerable risk of relapse after 1 year, which continues to increase over time. Younger age, anti-TNF monotherapy at the time of discontinuation, and immunomodulator-refractory disease were identified as risk factors for relapse.

“It might be reasonable to discontinue anti-TNF therapy in patients with UC in sustained remission,” said Dr Monique Devillers (Erasmus Medical Centre, the Netherlands). “It reduces healthcare costs, removes anti-TNF side effects, and may align with patient preference.” However, cessation of anti-TNF therapy comes with an increased risk of relapse. Therefore, careful patient selection is warranted. Dr Devillers and colleagues assessed relapse rates in patients with UC who discontinued anti-TNF therapy and aimed to identify predictors of relapse [1].

The research team included data from 8 anti-TNF trials in an individual participant data meta-analysis (n=654). Dr Devillers showed that the relapse rate was 22.7% after 1 year, increasing to 33.6% at 2 years, and 55.5% at 5 years of follow-up. Furthermore, she mentioned that an older age at discontinuation had a protective effect (per 10 years; HR 0.80; 95% CI 0.72-0.88), whereas the indication ‘immunomodulator refractory’ was a risk factor for relapse (HR 1.50; 95% CI 1.10-2.20) as was the absence of concomitant thiopurine therapy after anti-TNF cessation (HR 1.80; 95% CI 1.10-3.00). “We tested the model’s performance and found a Harrell’s C of only 0.55,” added Dr Devillers. “The limited discriminative ability of our model underscores the need for refinement.” Further research should explore whether assessing microscopic remission, as well as molecular and immunological markers of disease control, can improve risk prediction.

Anti-TNF cessation among patients with UC in sustained remission carries a considerable risk of relapse. However, the authors identified some predictors of relapse, highlighting that careful patient selection for anti-TNF cessation warrants further research.

1. Devillers MJC, et al. Risk of relapse after cessation of anti-TNF therapy in ulcerative colitis in corticosteroid-free clinical remission: an individual participant data meta-analysis (IPD-MA) on 654 patients from 8 studies. LB04, Late-breaking trials in IBD. UEG Week, 4-7 October 2025, Berlin, Germany.

Medical writing support was provided by Robert van den Heuvel.
Copyright ©2025 Medicom Publishing Group



Posted on 9 October 2025