Is Deep Remission the Right Time to De-Escalate Biologic Therapy in IBD? A Single-Center Retrospective Study

Area of Science:

• Gastroenterology
• Immunology
• Pharmacology

Background:

• Long-term biologic therapy with immunomodulators for inflammatory bowel disease (IBD) carries risks of severe side effects.
• Assessing the impact of discontinuing anti-tumor necrosis factor (anti-TNF) therapy after achieving mucosal healing is crucial for managing IBD.

Purpose of the Study:

• To investigate whether discontinuing anti-TNF treatment after two years in IBD patients with mucosal healing is associated with lower relapse rates.
• To evaluate the role of "deep remission" (clinical, endoscopic, and histological healing) in guiding anti-TNF therapy de-escalation.

Main Methods:

• Retrospective analysis of 64 IBD patients (25 ulcerative colitis, 39 Crohn's disease) who achieved mucosal healing after ≥2 years of anti-TNF therapy.
• Evaluation of endoscopic activity using Mayo endoscopic sub-score and SES-CD, and histological activity using GHAS (CD) and Nancy index (UC).
• Follow-up assessment of relapse rates and time to relapse after anti-TNF cessation.

Main Results:

• Of 64 patients, 60.9% achieved deep remission. After a median follow-up of 38.6 months, 57.8% relapsed, with a median time to relapse of 13.5 months.
• Histological activity at the time of anti-TNF withdrawal was moderately correlated with subsequent relapse (rho = 0.467, p < 0.001).
• Patients with histologically active disease at de-escalation had a significantly higher probability of relapsing within 4 years (OR 2.72).

Conclusions:

• Deep remission may inform decisions on therapy de-escalation in IBD patients on anti-TNF therapy.
• Over half of patients in endoscopic remission relapsed after discontinuation, highlighting the need for caution and individualized assessment during de-escalation.