A guide to preparation of patients with inflammatory bowel diseases for anti-TNF-alpha therapy

A guide to preparation of patients with inflammatory bowel diseases for anti-TNF-alpha therapy

Author Fonseca Chebli, Julio Maria Google Scholar
Gaburri, Pedro Duarte Google Scholar
Chebli, Liliana Andrade Google Scholar
Rocha Ribeiro, Tarsila Campanha da Google Scholar
Tavares Pinto, Andre Luiz Google Scholar
Ambrogini Junior, Orlando Autor UNIFESP Google Scholar
Mourao Cintra Damiao, Aderson Omar Google Scholar
Institution Univ Fed Juiz de Fora
Universidade Federal de São Paulo (UNIFESP)
Universidade de São Paulo (USP)
Abstract Current therapy of moderate-to-severe inflammatory bowel disease (IBD) often involves the use of anti-tumor necrosis factor alpha (TNF-alpha) 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-alpha therapy. A thorough history to rule-out contraindications of this therapy and emphasis on monitoring guidelines are important steps preceding administration of anti-TNF-alpha 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-alpha agents have been considered to present a globally favorable benefit/risk ratio. However, it is important that in routine practice, initiation of anti-TNF-alpha therapy be carefully discussed with the patient, extensively explaining the potential benefits and risks of such treatment. Prior to starting anti-TNF-alpha 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-alpha 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-alpha therapy.
Keywords Inflammatory Bowel Disease
Ulcerative Colitis
Agents, Biological
Language English
Sponsor Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG)
Date 2014-03-26
Published in Medical Science Monitor. Smithtown: Int Scientific Literature, Inc, v. 20, p. 487-498, 2014.
ISSN 1643-3750 (Sherpa/Romeo, impact factor)
Publisher Int Scientific Literature, Inc
Extent 487-498
Origin http://dx.doi.org/10.12659/MSM.890331
Access rights Open access Open Access
Type Review
Web of Science ID WOS:000333418100001
URI http://repositorio.unifesp.br/11600/44877

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