University of Manitoba IBD Clinical and Research Centre and Department of Internal Medicine, Winnipeg, Manitoba, Canada.
Am J Gastroenterol. 2013 Dec;108(12):1835-42, quiz 1843. doi: 10.1038/ajg.2013.294. Epub 2013 Sep 17.
Tumor necrosis factor (TNF) inhibitors are being increasingly utilized in the management of inflammatory bowel disease (IBD). Although the benefits associated with TNF inhibitor therapy are undeniable, concerns have been raised about the associated risk of infectious and malignant complications. In this narrative review, we will present the evidence from studies that have evaluated the association of TNF inhibitors and both overall and specific infections and malignancy. Overall, although TNF inhibitors may increase the risk of tuberculosis, varicella, and other opportunistic infections, there is little evidence suggesting that anti-TNF agents specifically raise the overall risk of serious infections. Similarly, there is little evidence that TNF antagonists raise the risk of developing malignancy over and above the risks from concomitant therapies and the underlying disease process. However, the risk of nonmelanoma skin cancers may be increased and that is further enhanced by use of combination TNF inhibitor and thiopurine therapy. The risk of non-Hodgkin's lymphoma is statistically increased among combination therapy users. The absolute risk remains a very small but feared risk. It is difficult to fully quantify the risk of these cancers among users of TNF inhibitor therapy in the absence of concurrent thiopurine therapy. We recommend that clinicians remain mindful about the potential risks of infectious and malignant complications in their IBD patients who are using TNF inhibitors, but that further research is required to better study these risks over the long-term course of therapy.
肿瘤坏死因子（TNF）抑制剂在炎症性肠病（IBD）的治疗中被越来越多地应用。虽然 TNF 抑制剂治疗带来的益处是不可否认的，但人们对相关感染和恶性并发症的风险表示担忧。在本叙述性综述中，我们将介绍评估 TNF 抑制剂与整体和特定感染以及恶性肿瘤之间关联的研究证据。总体而言，尽管 TNF 抑制剂可能会增加结核、水痘和其他机会性感染的风险，但几乎没有证据表明抗 TNF 药物会特异性增加严重感染的总体风险。同样，几乎没有证据表明 TNF 拮抗剂会增加恶性肿瘤的风险，超过伴随治疗和潜在疾病过程的风险。然而，非黑色素瘤皮肤癌的风险可能会增加，并且联合使用 TNF 抑制剂和硫嘌呤治疗会进一步增强这种风险。联合治疗使用者患非霍奇金淋巴瘤的风险在统计学上有所增加。绝对风险仍然是一个非常小但令人担忧的风险。在没有同时使用硫嘌呤治疗的情况下，很难在 TNF 抑制剂治疗的使用者中充分量化这些癌症的风险。我们建议临床医生在使用 TNF 抑制剂的 IBD 患者中注意潜在的感染和恶性并发症风险，但需要进一步的研究来更好地研究这些风险在长期治疗过程中的情况。
