National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.
Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
Aliment Pharmacol Ther. 2019 Mar;49(6):664-680. doi: 10.1111/apt.15097. Epub 2019 Feb 8.
Biological therapy is currently widely used to treat IBD. Infliximab, adalimumab and golimumab are currently licensed anti-TNF therapies. Biosimilar anti-TNF monoclonal antibodies are increasingly used. Anti-TNF therapies are widely used and their adverse effects are well characterised, and may cause significant morbidity and mortality in a small proportion of exposed patients. Gastroenterologists need to understand the mechanisms for these effects, recognise these swiftly and manage such events appropriately.
To cover the range of potential adverse reactions as a result of biologic therapy and specifically management of these events.
A Medline and Pubmed search was undertaken. Search terms included were "anti-TNF," "infliximab" or "adalimumab" or "golimumab" combined with the keywords "ulcerative colitis" or "Crohn's disease" or "inflammatory bowel disease" and then narrowed to articles containing the keywords "complications," "side effects" or "adverse events" or "safety profile." International guidelines were also reviewed where relevant.
Adverse events discussed in this review include infusion reactions, blood disorders and infections (including bacterial, viral, fungal and opportunistic infections) as well as autoimmune, dermatological disorders, cardiac and neurological conditions. Malignancies including solid organ, haematological and those linked to viral disease are discussed.
Anti-TNF therapy has wide-ranging effects on the immune system resulting in a spectrum of potential adverse events in a small proportion of patients. Research advances are improving the understanding, recognition and management of these adverse events.
生物疗法目前广泛用于治疗 IBD。英夫利昔单抗、阿达木单抗和戈利木单抗是目前获准的抗 TNF 治疗药物。生物类似物抗 TNF 单克隆抗体的应用日益增多。抗 TNF 治疗药物广泛应用，其不良反应已得到充分认识，在一小部分暴露于这些药物的患者中可能导致严重的发病率和死亡率。胃肠病学家需要了解这些作用的机制，迅速识别这些作用，并适当地管理这些事件。
涵盖生物治疗可能引起的一系列潜在不良反应，并特别管理这些事件。
进行了 Medline 和 Pubmed 检索。使用的搜索词包括“抗 TNF”、“英夫利昔单抗”或“阿达木单抗”或“戈利木单抗”，并与“溃疡性结肠炎”或“克罗恩病”或“炎症性肠病”的关键词相结合，然后缩小到包含“并发症”、“副作用”或“不良反应”或“安全性概况”等关键词的文章。在相关情况下，还审查了国际指南。
本综述讨论的不良反应包括输注反应、血液疾病和感染（包括细菌、病毒、真菌和机会性感染）以及自身免疫、皮肤病、心脏和神经系统疾病。还讨论了恶性肿瘤，包括实体器官、血液系统以及与病毒疾病相关的恶性肿瘤。
抗 TNF 治疗对免疫系统有广泛的影响，导致一小部分患者出现一系列潜在的不良反应。研究进展正在提高对这些不良反应的认识、识别和管理。
