The Relapse Rate of Inflammatory Bowel Disease (IBD) in  Patients Who Discontinue Anti-TNF Therapy: A Systematic  Review and Meta-Analysis

Fatemeh  Ebrahimi; Samaneh  Torkian; Elahe  Zare-Farashbandi; Babak  Tamizifar

doi:10.18502/ijph.v53i9.16452

Fatemeh Ebrahimi Department of Epidemiology & Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
Samaneh Torkian Department of Epidemiology, School of Health, Iran University of Medical Sciences, Tehran, Iran
Elahe Zare-Farashbandi Clinical Informationist Research Group, Health Information Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Babak Tamizifar Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

DOI: https://doi.org/10.18502/ijph.v53i9.16452

Keywords: Inflammatory bowel diseases; Treatment discontinuation; Relapse; Tumor necrosis factor; Anti-TNF

Abstract

Background: Inflammatory bowel disease (IBD) patients who cease anti-tumor necrosis factor (TNF) therapy are at risk of relapse, which is a matter of concern for the medical community. This study aimed to determine the relapse rate of IBD in patients who cease anti- TNF therapy.

Methods: A systematic search of international databases (Medline, Web of Sciences, Scopus, and EMBASE) was conducted until Mar 9th, 2022. The random effects model was used to calculate the IBD relapse rate, accompanied by a 95% confidence interval.

Results: The IBD relapse rate in patients who discontinued anti-TNF therapy was 44%. The pooled IBD-UC and IBD-CD relapse rate in patients who stopped anti-TNF therapy were 43% and 46%, respectively. The studies using infliximab (IFX) showed a pooled IBD relapse rate of 45%, and the IBD relapse rate in the IFX/ADA (Adalimumab) group was 42%. The IBD relapse rate for papers with treatment durations of less than or equal to 12 months was 51%, while for articles with treatment durations of more than 12 months, it was 30%.

Conclusion: This study emphasizes the need for careful evaluation and monitoring of IBD patients who cease anti-TNF therapy, as well as further investigation of alternative treatments for those who exhibit intolerance or inadequate response to anti-TNF therapy.