Anti-tumor Necrosis Factor in Patients With Ulcerative Colitis in Clinical Remission: to Continue or Not?

Inclusion Criteria: * confirmed diagnosis of ulcerative colitis * treated for minimum 1 year with first-line anti-tumor necrosis factor (TNF) treatment * in sustained clinical remission during the last 3 months * capable of understanding and signing an informed consent form Exclusion Criteria: * Discontinuation of systemic 5-Aminosalicylic acid (ASA) or immunomodulatory therapy or other medication that could affect disease activity during the last 3 months prior to randomization * Any treatment of systemic corticosteroids due to disease exacerbation during the last 3 months (i.e. patients being in steroid free clinical remission) * Patients on anti-TNF monotherapy with intolerance to both 5-ASA and immunomodulatory therapy * Change in the anti-TNF treatment during the last 3 months due to disease related factors, not including dose/frequency adjustments due to drug concentration measurements * Use of any second-line anti-TNF medication irrespective of reason for stopping first-line anti-TNF * Previous failed attempts of anti-TNF discontinuation of more than 4 months' duration, with the exception of discontinuation due to pregnancy * Detection of anti-TNF antibodies in moderate-high titers prior to randomization * Psychiatric or mental disorders * Alcohol abuse or other substance abuse * language barriers or other factors which makes adherence to the study protocol impossible * Participation in any other studies * pregnancy * breastfeeding