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26 March 2014 : Review article  

A guide to prepare patients with inflammatory bowel diseases for anti-TNF-α therapy

Júlio Maria Fonseca ChebliABDEFG, Pedro Duarte GaburriABEF, Liliana Andrade ChebliBDEF, Tarsila Campanha da Rocha RibeiroBDEF, André Luiz Tavares PintoAEF, Orlando Ambrogini JúniorABDEF, Adérson Omar Mourão Cintra DamiãoABDEF

DOI: 10.12659/MSM.890331

Med Sci Monit 2014; 20:487-498

Abstract

ABSTRACT: Current therapy of moderate-to-severe inflammatory bowel disease (IBD) often involves the use of anti-tumor necrosis factor alpha (TNF-α) agents. Although very effective, theses biologics place the patient at increased risk for developing infections and lymphomas, the latter especially when in combination with thiopurines. Appropriate patient selection, counseling, and education are all important features for the successful use of anti-TNF-α therapy. A thorough history to rule-out contraindications of this therapy and emphasis on monitoring guidelines are important steps preceding administration of anti-TNF-α agents. This therapy should only be considered if a recent evaluation has established that the patient has active IBD. In addition, it is important to exclude disease mimickers. Anti-TNF-α agents have been considered to present a globally favorable benefit/risk ratio. However, it is important that in routine practice, initiation of anti-TNF-α therapy be carefully discussed with the patient, extensively explaining the potential benefits and risks of such treatment. Prior to starting anti-TNF-α therapy, the patients need to be screened for latent tuberculosis, hepatitis B virus infection, and (usually) hepatitis C virus and HIV infection. Vaccination schedules of IBD patients should be evaluated and updated prior to the commencement of anti-TNF-α therapy. Ordinarily, immunization in adult patients with IBD should not deviate from recommended guidelines for the general population. With the exception of live vaccines, immunizations can be safely administered in patients with IBD, even those on immunosuppressants or biologics. The purpose of this review is providing an overview of appropriate steps to prepare patients with IBD for anti-TNF-α therapy.

Keywords: Antibodies, Monoclonal - therapeutic use, Communicable Diseases - diagnosis, Counseling, Inflammatory Bowel Diseases - drug therapy, Patient Selection, Practice Guidelines as Topic, Tumor Necrosis Factor-alpha - antagonists & inhibitors

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750