Review article: managing the adverse events caused by anti-TNF therapy in inflammatory bowel disease

Shivaji, Uday N.; Sharratt, Caroline L.; Thomas, Tom; Smith, Samuel C.L.; Iacucci, Marietta; Moran, Gordon W.; Ghosh, Subrata; Bhala, Neeraj

Abstract

Background: Biological therapy is currently widely used to treat inflammatory bowel disease (IBD). Infliximab, adalimumab and golimumab are currently licensed anti-TNF therapies. Biosimilar anti-TNF monoclonal antibodies are increasingly used. Anti-TNF therapies are most widely used and their adverse effects are best characterised, which may cause significant morbidity and mortality in a small proportion of exposed patients. Gastroenterologists need to understand the mechanism for these effects, recognise these swiftly and manage such events appropriately.
Aim: This review aims to cover the range of potential adverse reactions as a result of biologic therapy and specifically management of these events.
Methods: A Medline and Pubmed search was undertaken. Search terms included were “anti-TNF”, “infliximab” or “adalimumab” or “golimumab” combined with the keywords “ulcerative colitis” or “Crohn’s disease” or “inflammatory bowel disease” and then narrowed to articles containing the keywords “complications”, “side effects” or “adverse events” or “safety profile”. International guidelines were also reviewed where relevant.
Results: Adverse events discussed in this review include infusion reactions, blood disorders and infections (including bacterial, viral, fungal and opportunistic infections) as well as autoimmune, dermatological disorders, cardiac and neurological conditions. Malignancies including solid organ, haematological, and those linked to viral disease are discussed.
Conclusions: Anti-TNF therapy has wide-ranging effects on the immune system resulting in a spectrum of potential adverse events in a small proportion of patients. Research advances are improving understanding, recognition and management of these adverse events.

Citation

Shivaji, U. N., Sharratt, C. L., Thomas, T., Smith, S. C., Iacucci, M., Moran, G. W., Ghosh, S., & Bhala, N. (2019). Review article: managing the adverse events caused by anti-TNF therapy in inflammatory bowel disease. Alimentary Pharmacology and Therapeutics, 49(6), 664-680. https://doi.org/10.1111/apt.15097

• Journal Article Type: Article
• Acceptance Date: Nov 24, 2018
• Online Publication Date: Feb 8, 2019
• Publication Date: 2019-03
• Deposit Date: Nov 27, 2018
• Publicly Available Date: Feb 9, 2020
• Journal: Alimentary Pharmacology and Therapeutics
• Print ISSN: 0269-2813
• Electronic ISSN: 1365-2036
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 49
• Issue: 6
• Pages: 664-680
• DOI: https://doi.org/10.1111/apt.15097
• Keywords: Crohn’s, Ulcerative Colitis, Infliximab, Adalimumab, Golimumab, Biologics, Anti-TNFα Complications, Adverse events
• Public URL: https://nottingham-repository.worktribe.com/output/1313286
• Publisher URL: https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15097
• Additional Information: This is the peer reviewed version of the article , which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15097 . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
• Contract Date: Nov 27, 2018