The safety profile of anti‐tumour necrosis factor therapy in inflammatory bowel disease in clinical practice: analysis of 620 patient‐years follow‐up

Abstract

SUMMARY BackgroundAnti-TNF agents are now widely used in Crohn's disease (CD), and in ulcerative colitis (UC).

Cutaneous Adverse Reactions during Anti-Tnf Alpha Treatment for Inflammatory Bowel Diseases: The Experience of the Dermatology Clinic of Cagliari

“…Viral etiology is by far the most common observation, although bacterial infections were clinically more severe, as well as the occurrence of a dermatophyte infection and a cutaneous leishmaniasis might be worth of note in the present survey (Figure 1). A slight increased association with the administration of Infliximab was noted (14/8 cases; 63%), further in agreement with literature, reporting an increased risk of 2.51 times compared to naive subjects [18]. In contrast with literature, reporting several life-threatening infections associated with anti-TNF alpha therapy [10,32,[45][46][47], our patients experienced mild to moderate diseases, mostly self-resolving and/or successfully treated with specific systemic and topical therapy (90%).…”

“…Skin infections were the most frequent adverse event observed (32%), as well as reported in current literature findings [13][14][15]18]. Viral etiology is by far the most common observation, although bacterial infections were clinically more severe, as well as the occurrence of a dermatophyte infection and a cutaneous leishmaniasis might be worth of note in the present survey (Figure 1).…”

“…A wide range of skin manifestations has been described: infusion systemic reactions and at the injection site [16,17], infectious complications [18], eczematous dermatitis [13,19], psoriasis [20,21], and non-melanoma skin cancer [22,23].…”

Carcinogenesis in Ulcerative Colitis

“…Consequently, mucosal inflammation is clearly associated in CRC development and tailoring treatments towards mucosal healing should, therefore, curtail the risk of CRC development. However serious infections, malignancies -namely lymphomas -and neurological disease all complicate current anti-TNF treatments and longterm immunosuppression in IBD patients (Lees et al, 2009). Long-term follow up data is lacking, especially for combination therapies, but it appears that thiopurines are associated with a 3-5 fold increase in lymphoma risk and there is as much as a 3-fold increased relative risk for anti-TNF therapies (Bewtra & Lewis 2010).…”

A prospective study of infliximab withdrawal after 12 months of treatment in patients with Crohn’s disease: how will NICE guidance affect patient care?

“…6 Biological agents are, however, expensive and have the potential to cause significant side effects, such as serious infections and possibly an increased risk of malignancy. 7,8 In 2007, NICE was asked to appraise the clinical and cost effectiveness of biological agents within their licensed indications for Crohn's disease. In May 2010, a technology appraisal (TA187) 9 was published that made recommendations on the use of infliximab or adalimumab in patients with Crohn's disease.…”