Long-term anti-TNF use works wonders in moderate to severe IBD

The use of antitumour necrosis factor (anti-TNF) agents for at least 60 months is not only safe but also effective in the treatment of moderate to severe inflammatory bowel disease (IBD), according to a study presented at AIBD 2025.

“The achievement of mucosal healing correlates with improved clinical control,” said lead author Dr Pedro V Fachin, Faculdade de Medicina de Mogi das Cruzes, Mogi Das Cruzes, São Paulo, Brazil.

“Importantly, the therapy not only enhanced patients’ quality of life but also appears to modify disease course, as no patient required surgery after initiating treatment,” he added.

Fachin and his team conducted this retrospective study to assess the long-term behaviour of moderate to severe Crohn’s disease (CD) or ulcerative colitis (UC) in patients being treated with anti-TNF (either infliximab or adalimumab) for more than 60 months. They identified participants using medical records.

The authors then collected data, including demographic information, clinical history, surgical history, medication regimen, adverse effects, and clinical or endoscopic response.

Seventy-four patients with IBD had been treated for 5 years, of whom 10 (13.5 percent, mean age 46.1 years) received anti-TNF therapy exceeding 60 months. Of these, six were male and four female, with seven diagnosed with CD and three with UC. The average disease duration was 13.3 years, and the mean age at symptom onset was 31 years. [AIBD 2025, abstract 7]

Five out of seven patients with CD had perianal disease, which suggested a severe disease phenotype. Moreover, four of the 10 patients had undergone previous surgical procedures before initiating anti-TNF therapy, and none of these individuals had to undergo subsequent surgery following treatment initiation.

The average duration of therapy was about 74.8 months. Eight patients started treatment with infliximab, while the remaining two had adalimumab as their initial therapy.

Among the infliximab users, two (25 percent) faced secondary loss of response at 72 and 84 months and were then transitioned to adalimumab. On the other hand, the two patients who received adalimumab as initial therapy maintained adequate response for 60 months.

Adverse effects

Notably, none of the patients developed serious infections, but one had recurrent episodes of herpes labialis, which was manageable.

Four patients had intermittent use of corticosteroids, while six were treated with the combination of anti-TNF and azathioprine initially, but two of them eventually transitioned to monotherapy.

Following endoscopic procedure, four patients were found to have achieved complete mucosal healing and were asymptomatic. The remaining six patients exhibited minimal residual inflammation or radiological signs, with two remaining asymptomatic.

“These findings support the long-term safety and efficacy of anti-TNF therapy in IBD management,” Fachin said.

“IBD, including CD and UC, are chronic inflammatory conditions of the gastrointestinal mucosa with largely unknown aetiology,” the authors said.

“Anti-TNF agents, such as infliximab and adalimumab, have demonstrated significant therapeutic benefits, including a reduction in hospitalizations, surgical interventions, and a potential modification of disease progression,” they added.