Evidence map›Paper›PMID 41331357›Full record

SynthesisInternational journal of colorectal disease2025

TNF antagonists withdrawal is not advised in patients with inflammatory bowel disease in remission: a systematic review and meta-analysis of randomized controlled trials.

Ahmed Adekunle Owolabi, Iqra Qazi, Nadia Ahmed, Mariam Amro Alsayed, Muhammad Abu Zar, Taimour Rashid Choudhry, Dhanushan Gnanendran, Aqsa Khan, Amrutha Amrutha, Huzaifa Ahmad Cheema and 5 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in International journal of colorectal disease, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Ahmed Adekunle OwolabiDepartment of Acute Medicine, Stockport NHS Foundation Trust, Stockport, UK.
Iqra QaziDepartment of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX, USA.
Nadia AhmedDepartment of Internal Medicine, Ain Shams University, Cairo, Egypt.
Mariam Amro AlsayedDepartment of General Medicine, Batterjee Medical College, Jeddah, Saudi Arabia.
Muhammad Abu ZarDepartment of Internal Medicine, UT Southwestern, Dallas, TX, USA.
Taimour Rashid ChoudhryDepartment of Medicine, Kettering General Hospital NHS Trust, Kettering, UK.
Dhanushan GnanendranFaculty of Health, University Hospitals Plymouth NHS Foundation Trust, Plymouth, UK.
Aqsa KhanDepartment of Internal Medicine, Parkview Health, Fort Wayne, IN, USA.
Amrutha AmruthaDepartment of Gastrointestinal Surgery, Gem Hospital and Research Centre, Thrissur, India.
Huzaifa Ahmad CheemaDepartment of Medicine, King Edward Medical University, Lahore, Pakistan.
Asma'a Munasar Ali AlsubariFaculty of Medicine, Sana'a University, Sana'a, Yemen. asmamunasar@gmail.com.
Essam RashadDepartment of Internal Medicine, Parkview Health, Fort Wayne, IN, USA.
Adnan BhatDivision of Hospital Medicine, University of Florida, Gainesville, FL, USA.
Faryal AltafDepartment of Internal Medicine, Icahn School of Medicine at Mount Sinai, Bronx Care Health System, Bronx, NY, USA.
Prasun K JalalSection of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTumor necrosis factor (TNF) antagonists are central to the management of inflammatory bowel disease (IBD), but concerns regarding long-term safety, infection risk, and costs have prompted interest in treatment de-escalation. Whether discontinuing TNF therapy in patients with sustained remission is safe remains uncertain.

methodsWe performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TNF antagonist withdrawal with continuation in IBD patients in sustained remission. Databases including MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched through July 2025. Eligible trials enrolled adults with Crohn's disease or ulcerative colitis in clinical remission. Primary outcomes were relapse risk and sustained remission. Data were pooled using a random-effects model.

resultsFour RCTs comprising 485 patients were included. TNF antagonist withdrawal was associated with a significantly higher risk of relapse compared with continuation (RR: 3.00, 95% CI: 1.47-6.11). Time to relapse was also shorter in the withdrawal group (HR: 5.34, 95% CI: 2.05-13.92). Sustained clinical remission did not differ significantly between groups (RR: 0.83, 95% CI: 0.55-1.27). Withdrawal reduced infection risk (RR: 0.47, 95% CI: 0.25-0.90), while rates of gastrointestinal and serious adverse events were comparable.

conclusionsDiscontinuation of TNF antagonists in IBD patients in remission substantially increases the risk and accelerates the timing of relapse, though it lowers infection risk. Careful patient selection and close monitoring are essential if withdrawal is considered.

Indexed as

Inflammatory Bowel DiseasesTumor Necrosis Factor InhibitorsWithholding TreatmentHumansPublication BiasRandomized Controlled Trials as TopicRecurrenceRemission InductionTreatment OutcomeTumor Necrosis Factor InhibitorsAntagonists and inhibitorsInflammatory bowel diseaseMeta-analysisTumor necrosis factor-alpha

Identifiers

PMID41331357
PMCPMC12672724

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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.