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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


Uday N. Shivaji

Caroline L. Sharratt

Tom Thomas

Samuel C.L. Smith

Marietta Iacucci

Professor of Gastroenterology

Subrata Ghosh

Neeraj Bhala


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.


Shivaji, U. N., Sharratt, C. L., Thomas, T., Smith, S. C., Iacucci, M., Moran, G. W., …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.

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
Keywords Crohn’s, Ulcerative Colitis, Infliximab, Adalimumab, Golimumab, Biologics, Anti-TNFα Complications, Adverse events
Public URL
Publisher URL
Additional Information This is the peer reviewed version of the article , which has been published in final form at . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.


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