Understanding the Cautions and Contraindications of Immunomodulator and Biologic Therapies for Use in Inflammatory Bowel Disease

H. Matthew Cohn, Maneesh Dave, Edward V. Loftus

Research output: Contribution to journalReview articlepeer-review

Abstract

Ulcerative colitis and Crohn's disease are chronic inflammatory bowel diseases for which there are no cures. These diseases are immunopathogenic, and medical treatment is centered on the temperance of a dysregulated immune response to allow mucosal healing and prevent the sequelae of fistulation and stenosis. Accordingly, the armamentarium of medications, which has expanded immensely in recent history, is not without significant infectious and neoplastic risks. Many of these untoward effects can be mitigated by screening and avoidance of contraindicated medications. This review seeks to highlight the cautions for use of immunomodulators, anticytokine, and α4-integrin antagonists. The potential adverse events are further complicated by substantial heterogeneity in disease phenotype in the inflammatory bowel disease population. Large patient registries and databases provide considerable experience and knowledge to calculate the incidence of safety outcomes. To identify rarer outcomes after prolonged therapy, more prospective studies and continued adverse event reporting will aid safe application and minimize potential harms.

Original languageEnglish (US)
Pages (from-to)1301-1315
Number of pages15
JournalInflammatory bowel diseases
Volume23
Issue number8
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Keywords

  • adalimumab
  • azathioprine
  • certolizumab pegol
  • contraindications
  • Crohn's disease
  • golimumab
  • inflammatory bowel disease
  • infliximab
  • mercaptopurine
  • methotrexate
  • natalizumab
  • ulcerative colitis
  • ustekinumab
  • vedolizumab

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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