Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 7, 2009; 15(17): 2067-2073
Published online May 7, 2009. doi: 10.3748/wjg.15.2067
Safety of anti-tumor necrosis factor therapy in inflammatory bowel disease
Frank Hoentjen, Ad A van Bodegraven
Frank Hoentjen, Ad A van Bodegraven, Department of Gastroenterology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
Author contributions: This manuscript was written and revised by Hoentjen F and van Bodegraven AA.
Correspondence to: Frank Hoentjen, MD, PhD, Department of Gastroenterology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. frank_hoentjen@med.unc.edu
Telephone: +31-20-4440554
Fax: +31-20-4440554
Received: February 21, 2009
Revised: March 27, 2009
Accepted: April 3, 2009
Published online: May 7, 2009

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.

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