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Background To evaluate the need for retreatment with anti-TNF due to relapse after discontinuation based on mucosal healing in inflammatory bowel disease (IBD), as well as the influencing factors and the response to reintroduction. Methods Descriptive retrospective study of IBD patients in whom anti-TNF treatment was discontinued after mucosal healing had been proved, between June 2009 and May 2016. Demographic and phenotypic characteristics, biologic and immunomodulator (IM) therapy history, laboratory markers and histopathologic evaluation were noted. We evaluated the relapse rate after discontinuation of anti-TNF, as well as the need for reintroduction and its success rate. Results We included 100 patients, 69 of them affected by Crohn’s disease (CD), 29 with ulcerative colitis (UC) and 2 unclassified colitis. From those with CD, inflammatory behaviour (62%) and ileocolonic localisation (53%) were the most frequent conditions. Seventy-four per cent of UC patients had pancolonic involvement. Biological therapy had been indicated because of corticodependence in 66% (vs. 32% corticorefractoriness). The anti-TNF drug was infiliximab in 60 patients, adalimumab in 38, 1 certolizumab and one had been treated with golimumab. Endoscopic biopsies showed quiescent disease in 63 of 83 patients. Eighty-three per cent of patients were treated with IM after removal of anti-TNF. After a mean follow-up of 57 months, 63 patients relapsed, 52 of them needing anti-TNF reintroduction. Reintroduction rates at 12, 36 and 60 months were 19.5%, 43.5% and 52% respectively with a response after the re-treatment of 76,6%. Univariant analysis showed a higher risk in CD (61 vs. 31%, p = 0.008). Within the CD patients, the risk of reintroduction was lower in A3 (30 vs. 66%, p = 0.03) and B2 (31 vs. 69%, p = 0.006) patterns, and higher if the indication had been corticodependence (68% vs. 37%, p = 0.02). Multivariant analysis confirms the protective effect of B2 behaviour and worse outcomes for corticodependence antecedent. Considering UC, the retreatment probability was superior for those patients without IM therapy after anti-TNF discontinuation (57 vs. 22%), although this association did not reach statistical significance (p = 0.08). Conclusion The risk of needing reintroduction of anti-TNF therapy after mucosal healing in IBD is around 50% in 5 years, being superior in CD patients. Reintroduction success rate is 76%. In CD, this risk is higher when the reason for starting anti-TNF was corticodependence, and much lower when stricturing/fibrotic pattern predominates. For UC patients, anti-TNF drugs should not be stopped if IM therapy cannot be held.

P556 Long-term probability of retreatment with anti-TNF therapy after discontinuation based on mucosal healing in inflammatory bowel disease