Tumor necrosis factor-like cytokine 1 A antagonists for inflammatory bowel disease: A systematic review and...

BACKGROUND AND OBJECTIVES: The therapeutic paradigm in inflammatory bowel disease (IBD) is rapidly evolving. Tumor necrosis factor-like cytokine 1A (TL1A) antagonists are agents with potential to mitigate both inflammation and fibrosis. Available studies show early signals of efficacy of this novel therapeutic class. We summarize the available literature on the use anti-TL1A, through this systematic review and meta-analysis.

We conducted a systematic review and meta-analysis to assess the outcome of TL1A antagonists in patients with ulcerative colitis and Crohn's disease. We searched PubMed, EMBASE, Scopus and CENTRAL electronic databases for eligible studies through October 10, 2025. All studies with TL1A antagonists reporting outcome in adult IBD patients were included. We assessed clinical response, clinical remission, endoscopic improvement and remission and Histologic Endoscopic Mucosal Improvement (HEMI). We also assessed the adverse events (AEs) with anti-TL1A use.

Of the 431 studies screened, 12 were included in the final analysis. The pooled clinical response rate was seen in 67% of patients with ulcerative colitis and 58% of patients with Crohn's disease, with an odds ratio (OR) of 4.07 (95% CI 1.55-10.70) and 2.96 (95% CI 1.36-6.42), respectively. Anti-TL1A appeared to achieve clinical remission with OR 3.75 (95% CI 2.04-6.89). The pooled proportion of UC patients with endoscopic improvement and remission were 41% (95% CI 0.36-0.46) and 13% (95% CI 0.10-0.17), respectively. Patients with UC on anti-TL1A had an odds of achieving HEMI of 5.51 (95% CI 1.86-16.34). The most common reported adverse events (AEs) were mild and included infections and infestations. AEs occurred in 48.3% patients with UC and 49.2% of patients with CD with serious AEs reported in 3.9% patients with UC and 4.6% patients with CD.

Anti-TL1A agents appear to be a promising therapeutic option in patients with IBD. Overall, anti-TL1A demonstrated an acceptable short-term safety profile, although mild adverse events were reported in almost half of treated patients.