Anti-TNF Cessation Crohn Relapse — RACP Adult Medicine MCQ

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ModerateGastroenterologyAnti-TNF Cessation Crohn RelapseRACP Adult Medicine

A 35-year-old man with Crohn disease (ileocolonic) on adalimumab has been in deep remission for 3 years (CRP normal, faecal calprotectin <50, mucosal healing on colonoscopy). He asks about stopping adalimumab. His gastroenterologist is considering drug tapering. What is the risk of relapse if adalimumab is stopped?

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Correct answer: D — ~35-50% relapse within 1 year

Stopping anti-TNF in Crohn disease after sustained deep remission carries ~35-50% relapse risk within 12 months (STORI trial). Predictors of successful cessation: deep remission (clinical + biomarker + endoscopic), combination therapy with immunomodulator, long duration of remission, and low CRP/faecal calprotectin at cessation. Most relapses respond to anti-TNF re-introduction (~90%). Tapering (dose reduction or interval extension) before cessation may improve outcomes. Close monitoring with faecal calprotectin after cessation is essential.

Reference: GESA – 2024 – Crohn; ECCO 2024; STORI Trial