Review of the safety with biologics in inflammatory bowel disease

Abstract

Biologics have completely changed the treatment (and life) of patients with inflammatory bowel disease (IBD). After the first ones, anti-tumor necrosis factor (TNF) biologics, two new biologics, with other therapeutic targets, are now in routine use in our patients, and some others are in different stages of research. They share many aspects, but differ in others, so their efficacy and safety may be different. Having predictors of efficacy and safety in a particular patient are one of the greatest challenges in IBD therapy, but we are far from achieving it. In any case, safety is key, especially in drugs used as maintenance therapy in a chronic disease such as IBD. Although biologics are generally safe when are used correctly, it is essential to be aware of their potential adverse events and their particularities in different situations. To minimize them, it is essential to use them in the ideal patient, to choose the right biologic at the right time, to carry out a series of prior measures before start them, and, finally, to monitor the treatment correctly. We will discuss the differences between biologics, essentially anti-TNF versus ustekinumab versus vedolizumab, in terms of adverse events as well as their particularities of use. Having the knowledge of their contraindications, use in special populations, the steps before start, and how to monitoring them is essential. Although sometimes there are alternatives to biologics such as "the new small molecules, " they are not the purpose of this review.