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Safety of anti-tumor necrosis factor therapy in inflammatory bowel disease

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Author(s): Frank Hoentjen, Ad A van Bodegraven

Journal: World Journal of Gastroenterology
ISSN 1007-9327

Volume: 15;
Issue: 17;
Start page: 2067;
Date: 2009;
Original page

Keywords: Anti-tumor necrosis factor | Biologics | Inflammatory bowel diseases | Crohn’s disease | Infliximab

ABSTRACT
Inflammatory bowel disease (IBD), in particular Crohn’s disease refractory to conventional therapy, fistulizing Crohn’s disease and chronic active ulcerative colitis, generally respond well to anti-tumor necrosis factor (TNF) therapy. However, serious side effects do occur, necessitating careful monitoring of therapy. Potential side effects of anti-TNF therapy include opportunistic infections, which show a higher incidence when concomitant immunosuppression is used. Furthermore, antibody formation against anti-TNF is associated with decreased efficacy and an increased frequency of infusion reactions. The hypothesis of a slightly increased risk of lymphomas in IBD patients treated with anti TNF-therapy is debatable, since most studies lack the specific design to properly address this issue. Alarmingly, the occurrence of hepatosplenic T-cell lymphomas coincides with combined immunosuppressive therapy. Despite the potential serious side effects, anti-TNF therapy is an effective and relatively safe treatment option for refractory IBD. Future research is needed to answer important questions, such as the long-term risk of malignancies, safety during pregnancy, when to discontinue and when to switch anti-TNF therapy, as well as to determine the balance between therapeutic and toxic effects.
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