Risk of infections associated with biological treatment in inflammatory bowel disease

Abstract

Tumor necrosis factor-α (TNF-α) inhibitors are biological agents introduced in the late 1990s for the treatment of different immune-mediated diseases as inflammatory bowel disease, rheumatoid arthritis and psoriasis. The most commonly used TNF-α antagonists are infliximab, adalimumab, and certolizumab pegol, and though highly effective in lowering inflammation, the efficacy must be weighed against the potential for adverse events. The treatment-induced immunosuppression is suspected to increase the risk of infections, including the risk of reactivation of latent tuberculosis, as the TNF-α cytokine plays an important role in the immune function. In this topic highlight a short overview of the infection risk associated with TNF-α inhibiter therapy is outlined with a focus on the overall risk of serious infections, mycobacterial infection and latent viral infections.

Keywords: Inflammatory bowel disease; Biological treatment; Tumor necrosis factor-α inhibitors; Risk; Infections; Ulcerative colitis; Crohn’s disease

Core tip: The use of tumor necrosis factor-α (TNF-α) inhibitors are increasing worldwide for the treatment of several chronic immune-mediated diseases as rheumatoid arthritis and inflammatory bowel disease (IBD). As the drugs are relatively new on the market, their long-term safety profile remains uncertain. In particular, a concern regarding an increased infections risk has been debated. In the current topic highlight, a brief overview of the current literature regarding the risk of infections in patients with IBD exposed to TNF-α inhibitors is outlined.