Safety and Efficacy of Anti-TL1A Monoclonal Antibodies in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Abstract

Background & Objective: Tumor necrosis factor-like ligand 1A (TL1A) has been associated with mucosal inflammation, fibrosis, and epithelial barrier dysfunction in inflammatory bowel disease (IBD). Monoclonal antibodies against TL1A have emerged as potential therapies for moderate-to-severe ulcerative colitis (UC) and Crohn's disease (CD). Our systematic review and meta-analysis aimed to evaluate their safety and efficacy as induction therapy. Methodology: PubMed, Cochrane Library, Scopus and ClinicalTrials.gov were searched through July 2026 for double-blind, placebo-controlled RCTs reporting clinical remission and/or endoscopic improvement at weeks 12-14. Single-arm studies were included only in the narrative synthesis. Risk of bias was assessed via Cochrane RoB 2. Dichotomous outcomes were pooled as risk ratios (RRs) using random-effects models. Results: Five studies met the inclusion criteria; three placebo-controlled RCTs underwent quantitative analysis, and two single-arm studies were narratively summarized. Compared to placebo, anti-TL1A therapy increased clinical remission (RR 3.31, 95% CI 1.43–7.68) and endoscopic improvement (RR 2.78, 95% CI 1.58–4.89). Histologic improvement (RR 2.30, 95% CI 1.55–3.41) and symptomatic remission (RR 3.75, 95% CI 1.80–7.83) were also noted. Overall adverse events were similar between groups (RR 0.96, 95% CI 0.78–1.18), though serious adverse events were lower with treatment (RR 0.33; 95% CI 0.11–0.98). Conclusion: Anti-TL1A monoclonal antibodies were linked to significant improvements in clinical, endoscopic, and histologic induction outcomes. However, evidence remains preliminary due to a few RCTs, scarce Crohn's disease data, and clinical remission estimates heavily influenced by a single trial. Larger phase 3 trials are necessary to confirm these findings. Key Words: Anti TLA1 Monoclonal antibodies, Inflammatory Bowel Disease.