SynthesisAlimentary pharmacology & therapeutics2021
Systematic review with meta-analysis: the effects of immunomodulator or biological withdrawal from mono- or combination therapy in inflammatory bowel disease.
Synthesis in Alimentary pharmacology & therapeutics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 3 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Second United Arab Emirates consensus guidance on the diagnosis and management of inflammatory bowel disease.World journal of gastroenterology · 2025Pooled it
- Management of paediatric ulcerative colitis, part 1: Ambulatory care-An updated evidence-based consensus guideline from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn's and Colitis Organisation.Journal of pediatric gastroenterology and nutrition · 2025Guideline
- Systematic review with meta-analysis: the effects of immunomodulator or biological withdrawal from mono- or combination therapy in inflammatory bowel disease.Alimentary pharmacology & therapeutics · 2021Pooled it
- Evaluation of the replicability of systematic reviews with meta-analyses of the effects of health interventions.Research synthesis methods · 2026Article
- Therapy de-escalation in paediatric patients with inflammatory bowel disease in remission: Data analysis from the CEDATA registry.Journal of pediatric gastroenterology and nutrition · 2026Article
- Relapse Rates and Predictors Following Azathioprine Withdrawal in Inflammatory Bowel Disease: A Systematic Review, Meta-Analysis, and Meta-Regression.Journal of clinical medicine · 2025Review
- Discontinuation of therapy in inflammatory bowel disease: Current views.World journal of clinical cases · 2024Review
- Multifunctional nanoparticle-mediated combining therapy for human diseases.Signal transduction and targeted therapy · 2024Review
- De-escalation of Therapy in Patients with Quiescent Inflammatory Bowel Disease.Gut and liver · 2023Review
- Evidence-Based Approach to the Discontinuation of Immunomodulators or Biologics in Inflammatory Bowel Disease.Digestion · 2023Review
- Combination Immunotherapy Use and Withdrawal in Pediatric Inflammatory Bowel Disease-A Review of the Evidence.Frontiers in pediatrics · 2021Review
- Thiopurines in Inflammatory Bowel Disease. How to Optimize Thiopurines in the Biologic Era?Frontiers in medicine · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWithdrawal of treatment is a common therapeutic problem in patients with long-standing remission of inflammatory bowel disease.
aimsTo evaluate the relapse rate in patients with quiescent inflammatory bowel disease after cessation of biologic or immunomodulator therapy.
methodsWe searched five databases for studies evaluating disease relapse after withdrawal of monotherapy or a drug from combination therapy in Crohn's disease or ulcerative colitis. In meta-analysis, risk ratios (RR) were calculated with 95% confidence intervals (CI).
resultsTen randomised controlled trials (587 patients) were included in the meta-analysis, and another nine studies in systematic review. Withdrawal of immunomodulator monotherapy resulted in a significantly higher risk of relapse within 24 months of follow-up compared to ongoing therapy in Crohn's disease, but not in ulcerative colitis (RR = 2.06, CI: 1.53-2.77 and RR = 1.39, CI: 0.85-2.26, respectively). Trial sequential analysis indicated that further studies with similar design are unlikely to change the significant association on relapse rates after withdrawing immunomodulator monotherapy in patients with Crohn's disease. Discontinuation of an immunomodulator from combination with biologics did not show a higher risk of relapse than continuation of both drugs (RR = 1.30, CI: 0.81-2.08). The relapse rate increased after withdrawal of biologic monotherapy, whereas contradictory results were observed after biologic withdrawal from combination regimens.
conclusionContinuing immunomodulator monotherapy should remain the preferred approach among patients with Crohn's disease, although long-term toxicity is a concern. Further randomised controlled trials are warranted in ulcerative colitis and on combination regimens including biologics.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.