The safety profile of anti-tumour necrosis factor therapy in inflammatory bowel disease in clinical practice: analysis of 620 patient-years follow-up.
BACKGROUND
Anti-TNF agents are now widely used in Crohn's disease (CD), and in ulcerative colitis (UC).


OBJECTIVE
To review the safety profile of anti-TNF agents in all patients treated with infliximab in Edinburgh from 1999 to 2007.


METHODS
Complete data were available on 202/207 patients comprising 157 CD, 42 UC and three coeliac disease. Median follow-up was 2.4 years (1.0-4.9) with a total of 620 patient-years follow-up. About 19.1% of CD patients were subsequently treated with adalimumab.


RESULTS
Seven deaths (3.3%) occurred in follow-up; only one death was <1 year post-infliximab (at day 72, from lung cancer). A total of six malignancies (three haematological, three bronchogenic) and six cases of suspected demyelination (three with confirmed neurological disease) were reported. In the 90 days following infliximab, 95 adverse events (36 serious) occurred in 58/202 (28.7%) patients. In all, 42/202 (20.8%) had an infectious event (22 serious) and 27/202 (13.4%) of patients had an infusion reaction: 19 acute (four serious) and eight delayed (three serious).


CONCLUSIONS
Serious infections, malignancies and neurological disease complicate anti-TNF use in clinical practice. Although evidence for causality is unclear, potential mechanisms and predisposing factors need to be explored. In individual patients, the risk/benefit analysis needs to be carefully assessed and discussed prior to commencement of therapy.
Lees
C W
CW
Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. charlie.lees@ed.ac.uk
Ali
A I
AI
Thompson
A I
AI
Ho
G-T
GT
Forsythe
R O
RO
Marquez
L
L
Cochrane
C J
CJ
Aitken
S
S
Fennell
J
J
Rogers
P
P
Shand
A G
AG
Penman
I D
ID
Palmer
K R
KR
Wilson
D C
DC
Arnott
I D R
ID
Satsangi
J
J
D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D001327:Autoimmune Diseases / Q000139:chemically induced / Q000401:mortality; D016903:Drug Monitoring; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007239:Infections / Q000139:chemically induced / Q000401:mortality; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D000069285:Infliximab; D008297:Male; D009369:Neoplasms / Q000139:chemically induced / Q000401:mortality; D012189:Retrospective Studies; D012713:Serum Sickness / Q000139:chemically induced / Q000401:mortality; D055815:Young Adult
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D000069285:Infliximab; D000068879:Adalimumab