Understanding the complications of anti‐tumor necrosis factor therapy in East Asian patients with inflammatory bowel disease

Abstract

Remarkable advances have been made in the treatment of inflammatory bowel disease since the introduction of anti‐tumor necrosis factor‐α agents, especially for patients who are refractory to or cannot tolerate conventional therapies. Currently, infliximab, adalimumab, and golimumab are available in the East Asian medical market, and these agents have been shown to be effective for inducing and maintaining long‐term remission of inflammatory bowel disease. Despite their clinical benefits, anti‐tumor necrosis factor therapy can also lead to increased vulnerability to infections, development of autoimmune diseases and malignancy, and decreased immunogenicity of vaccinations. Because infectious diseases, such as tuberculosis, hepatitis, and influenza, remain major health problems in East Asia, more cautious use of biologics is needed. To further improve treatment efficacy and safety, close monitoring of inflammation, regular surveillance for malignancy, and regularly scheduled vaccinations are needed. Treatment strategies for biologics should be customized to meet the needs of different patients.

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

“…Acute HBV reactivation due to immunosuppressive therapy in patients with IBD can be life-threatening; therefore, to minimize the risk of this complication, HBV screening should be performed prior to the initiation of immunomodulating/immunosuppressive agents for UC 5657…”

“…Major safety concerns with biologic therapy include infection and malignancy 56. Use of anti-TNF agents increases the risk of opportunistic infections, such as reactivation of TB 102.…”

Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

“…Over 8% of males over 35 years of age are positive for HBsAg in East Asia 85. Screening for HBV should be done prior to the initiation of immunomodulating/immunosuppressive therapy for CD to minimize the risk of acute HBV reactivation, which can be a life-threatening complication in patients with IBD 8687. HBV vaccination is recommended in patients who are negative for HBsAg, HBsAb, and HBcAb.…”

Could adalimumab be used safely and effectively in intestinal Behçet's disease refractory to conventional therapy?

“…Of 20 patients, 60% achieved marked improvement at week 52 and 20% achieved complete remission at weeks 24 and 52 4. Based on this open-label clinical trial and case reports, adalimumab was recently approved and recommended as a standard therapy for intestinal BD in Japan, Taiwan, and South Korea 56. More evidence should be accumulated for the concrete conclusion that adalimumab is effective in the treatment of intestinal BD.…”